Shortage of common drugs compounds harsh flu, RSV season

Published 11/18/2022 6:00 a.m. EST, Updated 11/21/2022 9:30 a.m. EST

Meghan Grogan holds her infant son Max Mauler.

After Meghan Grogan’s son, Max, was recently diagnosed with RSV, doctors at an urgent care center also found that the congested 11-month-old boy had developed infections in both ears.

That’s common, but what happened next was not. The pharmacy gave the family only half of a 10-day course of amoxicillin because it didn’t have enough in stock.

Grogan had to find another pharmacy to fill the other half.

“It’s already really scary with everything spreading around out there,” said Grogan. “We should be able to walk into a store and pick up drugs to treat this stuff.”

There is a national shortage of amoxicillin, the antibiotic widely used to treat bacterial infections in ears, sinuses and chests that crop up after someone catches a virus like RSV, the flu or COVID-19. Also short are some other common drugs such as Tamiflu, an antiviral used to lessen the severity of the flu, and a type of albuterol used in hospital and home settings to ease breathing difficulties.

The shortages are concerning medical providers and pharmacists as they see respiratory viruses roar back after coronavirus pandemic precautions such as masking suppressed them. They are bracing for the toughest cold-weather season in years and have already seen a rise in patients, particularly children.

Lisa Polinsky, assistant vice president of pharmacy services for LifeBridge Health, said the hospital system that includes Sinai Hospital in Baltimore has been meeting regularly to make sure there are enough medications in the right places when needed.

The amoxicillin shortage has been the biggest problem, and officials have done things such as order capsules and make them into the familiar liquid used for children. The process is time-consuming, and even with flavoring, the antibiotic remains a bit bitter, which any parent knows makes it harder to get kids to take it.

“Amoxicillin is short nationally, so everyone is having difficulty obtaining medication,” Polinsky said. “With all the RSV and flu going around, it’s a perfect storm. We are able to back up some supply for our kids by ordering capsules and compounding them if needed, but retail pharmacies may not have that ability.”

Dr. Panagis Galiatsatos, a pulmonary and critical care medicine doctor at Johns Hopkins Bayview Medical Center, said there are substitute antibiotics, but they are not as targeted to the infections. Wide use of more “broad spectrum” antibiotics could lead to more resistance, eventually making them ineffective.

“With these viruses yo,u’re set up for future infection because there is all this excess mucus laying around; a week later you get a sinus infection you can’t shake off,” he said. “Physicians need antibiotics but are going to need to be strategic when prescribing an antibiotic.”

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But he said he’s already hearing from pharmacists asking if he could prescribe them instead of amoxicillin.

The U.S. Food and Drug Administration lists several drugs in short supply

The FDA first reported a low supply of amoxicillin oral suspension powder – the raw material formulated to make kids’ antibiotic syrup – at the end of October. The FDA lists five manufacturers reporting shortages of children’s amoxicillin in multiple different dosages.

All of these companies except one list increased demand for the drug as the reason for its shortage.

Albuterol inhalation solution, a nebulized aerosol medication commonly used to help open the airways of adult and pediatric patients who are struggling to breathe, was also first listed in the FDA’s shortage database at the end of October.

Both manufacturers reporting shortages listed “other” as the reason. Akorn Pharmaceuticals, which produces albuterol solution in its standard 20 milliliter size, estimates that this product will not be available again until the second quarter of next year. Akorn could not be reached for comment with regard to the reason behind the current shortage.

It’s clear, however, that shortages are not all due to an increase in demand, said Tinglong Dai, a professor of operations management and business analytics in the Johns Hopkins University Carey Business School.

He said there have been shortages in the past, and supply chain experts have expressed concern specifically about “the fragility of our antibiotic supply chain,” which is “foreign-dependent and very opaque.”

Dai said a large proportion of antibiotics are made in other countries, with ingredients largely coming from China and India, making it hard for the United States to improve the system.

“What we know is that when a demand spike occurs, this supply chain is just incapable of ramping up production quickly enough to meet the challenge,” he said.

Officials from the national retail pharmacy giant CVS Health said they are working with manufacturers to replenish their supply of amoxicillin specifically. They are also assisting patients in finding their prescriptions at nearby CVS pharmacy locations and working with prescribers to determine alternatives.

If the shortages do not ease, patients may be in for more discomfort. Grogan said Max has proven prone to ear infections and she expects more need for antibiotics.

Galiatsatos said Hopkins hospitals are bracing for a lot more children and adults with infections.

“It’s only November, and I’m massively concerned about the upcoming months,” he said. “It’s likely to get worse.”