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Amoxicillin is one of the most commonly prescribed antibiotics in the United States. Edie Bloom/Getty Images
  • Amoxicillin is one of the most commonly prescribed antibiotics, used extensively to treat upper respiratory infections.
  • Health officials are reporting shortages of various forms of amoxicillin.
  • Experts say the shortages may be caused by the surge in upper respiratory infections this fall.
  • They note there are alternative treatments available.

A post-COVID-19 surge in upper respiratory infections may be driving demand for the liquid form of the antibiotic amoxicillin, prompting the U.S. Food and Drug Administration (FDA) to issue an alert about supply shortages.

In particular, officials say, the shortage could be due to the rise in cases of flu and RSV in children.

Amoxicillin is one of the most commonly prescribed antibiotics in primary care settings in the United States.

It’s commonly used to treat upper respiratory infections of the ears, nose, throat, urinary tract, and skin, according to Dr. Jodie L. Pepin, the clinical pharmacy program director at Harbor Health and a clinical assistant professor of pharmacy at the University of Texas at Austin.

“Amoxicillin is a broad spectrum antibiotic that is used for a wide variety of bacterial infections, making it a first-line therapy in many cases,” said Crystal A. Riley, PharmD, MHA, a doctor of pharmacology and health administration lecturer at New York University’s Robert F. Wagner Graduate School of Public Service.

The FDA first reported the shortage of amoxicillin oral solution in late October.

The “powder for suspension” form of amoxicillin, intended to be mixed with water, “is a very common antibiotic used in pediatric patients,” Pepin told Healthline.

The American Society of Hospital Pharmacists (ASHP), which maintains a current database on drug shortages, said that other versions of amoxicillin also are in short supply.

“The shortage is no longer isolated to oral suspensions,” said Pepin. “It now encompasses oral capsules, tablets, and chewable tablets as well… There is limited availability with some manufacturers, but this will likely result in shortages with those manufacturers due to increased demand [coupled with] the lack of product supplied by other manufacturers.”

Dr. Michael Ganio, PharmD, ASHP’s senior director of pharmacy practice and quality, told Healthline that the shortage is “fairly significant” given the widespread use of amoxicillin.

“Patients and physicians may have to go to multiple pharmacies to find the drug, so that could be disruptive,” said Ganio.

Alternative therapies could also be required, such as treating infections with other antibiotics like azithromycin or cefalexin, he said.

Amoxicillin “is a very palatable medication, especially for children, easy to use and store, and inexpensive,” noted Pepin. “Other forms of the medications, capsules, tablets, and chewables are inexpensive as well, and all forms cover many of the most common bacteria that cause common infections.”

“As far as importance goes, there is not a compelling indication for amoxicillin; meaning there are alternative medications that will work as well,” Pepin added. “They may be more expensive and less easy to take, which can affect patient compliance, but generally, we would not be without a choice to treat these common infections.”

Drug manufacturers reported to ASHP that their supplies of many amoxicillin products are either on allocation or on backorder.

Some dosages of the antibiotic in pill form are in short supply but still available, according to Sandoz officials.

However, the pharmaceutical company could not predict a date when back-ordered amoxicillin products would once again be available.

Teva Pharmaceuticals officials said that various forms of its currently back-ordered amoxicillin products would be restocked beginning this month, but some won’t be available until January or February.

Ganio said that most of the 260 drug shortages listed in the ASHP database can be traced to quality control issues. The amoxicillin shortage is unusual, he said, in that it likely was caused by a surge in demand.

More doctors and patients have been seeking the drug in response to respiratory infections that have spread after two years of COVID-imposed quarantine and isolation, during which many individuals were far less exposed to the pathogens that cause these illnesses.

“Amoxicillin does not treat the viruses that we are dealing with in the pediatric population, currently including RSV, Influenza, and COVID-19, but does treat secondary bacterial infections that can result from the after-effects of a viral infection,” noted Pepin. “It seems to be a supply and demand issue at this stage.”

Pharmaceutical companies are normally astute in predicting seasonal surges in drug demand, but the intensity of the current outbreak was not anticipated, Ganio said.

Manufacturers themselves have offered no explanation for the current amoxicillin shortfall.

“What will determine how long the shortage lasts is how long the outbreak of respiratory infections lasts,” Ganio said.

Shortages of medication are not uncommon, experts said.

A prior shortage of amoxicillin occurred in 2016, for example.

“Drug shortages can occur for many reasons, including manufacturing and quality issues, delays due to raw material shortages, increased demand, and discontinuation of a drug,” said Pepin.

“From a broader perspective, shortages highlight the need to ensure that the U.S. pharmaceutical system has a robust supply chain and manufacturing capabilities, as well as continued research in new antibiotic therapies,” Dr. Oladele Ogunseitan, a professor of population health and disease prevention at the University of California at Irvine’s Program in Public Health, told Healthline.