Shortage of Common Antibiotics Persists Amidst Increasing Strep Cases
Shortage of common antibiotics persists amidst a surge in strep throat cases, adding to the burden of parents already grappling with Covid-19, flu, and RSV Stay informed with CNN Health's weekly newsletter
Many parents in the US are facing a challenging situation as they try to care for their sick children. The presence of Covid-19, the flu, and RSV is causing additional strain, and now doctors are reporting an increase in cases of strep throat. Data indicates a consistent rise in the number of strep throat cases from August onwards, primarily affecting children aged 4 to 12. However, the shortage of specific forms of amoxicillin, a commonly used antibiotic for treating this bacterial infection, is further complicating the situation.
Group A Streptococcus bacteria can cause many types of infections -- from mild to severe -- and they're most prevalent among children.
H_Ko/Shutterstock
Strep infections in the US surged this winter, up nearly 30% from pre-pandemic peak
According to the US Food and Drug Administration's drug shortage database, there has been a shortage of Amoxicillin powder, which is commonly used to create liquid antibiotic formulation for children, since October 2022.
The FDA acknowledges the impact of this shortage but emphasizes its inability to compel drug companies to increase production.
The four manufacturers of amoxicillin powder for oral suspension, which experienced a shortage last fall due to high demand, are actively working to recover and continue production. The agency stated on Tuesday that they will keep the website updated with the manufacturers' planned recovery dates and offer assistance to improve supply. While not all manufacturers have provided reasons for the shortfalls, most are still producing the antibiotic but have limited the amount that customers can order.
Amoxicillin emerged as the country's top prescribed antibiotic in 2021, as per CDC data, with a rate of 129 prescriptions filled per 1,000 individuals. In a 2022 report by US Pharmacopeia, it was highlighted that antibiotics, such as amoxicillin, face a 42% higher likelihood of experiencing shortages compared to other types of medications.
Although the shortage list does not include capsule and tablet variations of amoxicillin, experts warn against their suitability for young children who frequently struggle with swallowing pills, particularly when they are suffering from a sore throat.
Not all group A Strep bacteria are susceptible to amoxicillin, unlike erythromycin and azithromycin. These two antibiotics are sometimes used as alternatives, but there are cases where some group A Strep bacteria are resistant to them, as explained by Dr. Kristina Bryant, a pediatric infectious disease physician at Norton Children's Hospital in Louisville.
Strep on the rise
"Kids usually do not encounter any difficulties while consuming it and experience minimal side effects," she mentioned talking about amoxicillin, further elaborating that the alternative options do not have the same enjoyable flavor as the bubble-gum-flavored liquid version.
Strep throat is a common ailment among children between the ages of 5 and 15, as reported by the US Centers for Disease Control and Prevention. The peak infectious season generally occurs from December until April, with February being the peak month.
Data from Epic Research, a subsidiary of the healthcare software company Epic, indicates that the highest incidence of strep throat diagnoses is observed in children aged 4 to 8. Typically, the percentage of healthcare visits related to strep throat remains under 5% during the February peak. However, this year, there was a significant increase, surpassing 8% in early March.
The percentage of 4- to 8-year-olds in the US seeking healthcare for strep infections has risen gradually after hitting a low in early August. According to Epic data, during the week of October 21, just over 4% of children in this age group had a health care visit for a strep infection. Dr. Jennifer Stevenson, the director of the emergency department at Henry Ford Medical Center - Fairlane in Dearborn, Michigan, has observed a notable increase in strep cases this year, including during the summer.
On November 10, 2022, at Rush University Medical Center in Chicago, Selena Ko, an inpatient pharmacist, prepares amoxicillin, an antibiotic in powdered form, and calculates the appropriate doses for pediatric patients. (Image credit: Erin Hooley/Chicago Tribune/Tribune News Service via Getty Images)
Erin Hooley/Chicago Tribune/TNS/Getty Images/FILE
A new season of infections is here, but the shortage of a common kids antibiotic never ended
"We have observed a noticeable rise in the occurrence of strep infections," she stated. "Since March, strep has become the second most frequently diagnosed condition in the emergency department, which is quite unusual."
According to a report by Epic Research in April, the number of strep throat cases surged to a rate that was almost 30% higher than the previous peak in February 2017, following a significant decline during the Covid-19 pandemic.
Stevenson anticipates an increase in the cases of strep throat due to the ongoing precautions taken by individuals to safeguard against Covid-19. The comparison of numbers suggests that the current figures will surpass those of the previous year.
Bryant explains that predicting pediatric strep trends in the upcoming months is challenging because unlike Covid-19 and the flu, the CDC does not monitor these cases. She further points out that strep throat is a common and recurrent infection, hence the absence of a necessity to track it.
Symptoms to watch for
Group A Streptococcus, a type of bacteria, is the culprit behind strep throat, an infection that primarily affects the throat and tonsils. Common symptoms include fever, a sore throat, difficulty swallowing, and inflamed tonsils, as stated by the CDC. In some cases, individuals may also experience less frequent symptoms such as a headache, abdominal pain, or vomiting.
The bacteria commonly resides in the throat and spreads through respiratory droplets and direct contact, such as sharing a cup with an infected individual.
Healthcare providers typically confirm a group A Strep infection by conducting a throat culture or employing a rapid antigen detection test, as stated by the CDC. Rapid test outcomes are available within approximately 15 minutes, whereas results from a throat culture may take two or three days.
Once a strep throat test comes back positive, doctors will usually prescribe antibiotics like amoxicillin. Although a person usually stops being contagious after taking antibiotics for about 24 hours, it is crucial to continue taking the prescribed medications even after starting to feel better.
According to Bryant, some children may experience multiple strep infections in a year, which could give the impression that they are no longer responding to the medication.
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Sign up now to receive The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team. If antibiotics do not improve your child's strep throat, Bryant suggests that other bacteria in the throat could be reducing the effectiveness of the medication. The CDC also states that your child might be a carrier of strep. If this is the case, it's advised to consult a doctor regarding additional treatment options.
According to the CDC, there is currently no vaccine available to prevent infection. It is important for parents to remind their children to consistently wash their hands at school and to cover their mouths when coughing.
If your local pharmacy does not have amoxicillin available as prescribed for your child, Stevenson advises requesting an alternative medication from your doctor instead of leaving the infection untreated.
"If the strep infection is not treated, the person can potentially spread strep for weeks," she cautioned. "Furthermore, neglecting proper treatment can allow the bacteria to develop resistance against the antibiotics they have been exposed to."
This report includes contributions from CNN's Deidre McPhillips and Brenda Goodman.
