Shortage of 'first-line' antibiotic hits as surge in children's respiratory illnesses strains supply

Doctors and pharmacists in Canada are having trouble finding an important antibiotic for treating bacterial infections in children, and some are insisting a surge in respiratory illnesses is contributing to the shortage.

Amoxicillin is one of the most commonly used antibiotics, especially among young patients. But pharmacists and pediatricians told CBC Toronto they are struggling to find the drug.

"We are entering a shortage situation for a number of the different brands of the amoxicillin suspension. It does look like this supply shortage could run into the new year," said Jen Belcher, vice president of the Ontario Pharmacists Association.

According to Health Canada four, companies — Sanis Health Inc., Apotex Inc, GlaxoSmithKline Inc. and Teva Canada Limited — are reporting shortages of various products that contain amoxicillin. The federal agency says eight other manufacturers are not reporting shortages at this time.

In the United States, amoxicillin oral suspension powder is currently in short supply, according to the U.S. Food and Drug Administration. On the administration's website, Amoxicillin manufacturers say "increase in demand" is the reason why supplies are low.

'High levels of demand'

Belcher points to the same issue in Ontario. 

"We're just seeing exceptionally high levels of demand," shhe said.

The shortage comes as Ontario hospitals are seeing much higher numbers of children with respiratory illnesses. Some experts say the surge is likely due to patients' immune systems being under-prepared for exposure to pathogens following widespread COVID-19 isolation and physical distancing requirements. 

"We are seeing a huge surge in children who have communicable infections like colds, coughs and flu and those are those predisposed to bacterial infections," said Dr. Daniel Flanders, a pediatrician and the founder of the Kindercare clinic in Toronto.

Canada is also experiencing a shortage of pediatric pain medication, including children's Tylenol and Advil, a phenomenon experts have linked to supply chain problems, panic buying and the increase is illnesses.

Pharmacists making due

Amoxicillin is the "first line antibiotic" for bacterial infections in children, according to Flanders. He says it's economical and well-tolerated by patients. 

Flanders says that many of his patients' parents are now having to shop around various pharmacies to find one that has the drug in stock.

He says that pharmacists are also strategically rationing supplies and making their own suspensions to meet the need.

"I would say to date we're kind of hobbling along and sort of networking with our colleagues to stay on top of which pharmacies have what. The longer this goes on the harder it's going to be for us to keep it together and I think eventually it'll crumble and there will be people who are truly suffering," Flanders said.

Shortage could ease by end of year, manufacturer says

Only GlaxoSmithKline responded to questions about the shortage from CBC Toronto. 

The company says it is experiencing increased demand across the country for its drug Clavulin, which contains amoxicillin, in powder for oral suspension in the 125mg, 200mg and 400mg dosage forms.

"At this time, we anticipate the current shortages for the impacted dosage forms of Clavulin powder for oral suspension to be resolved between end-November to late-December," Janet Grdovich, GlaxoSmithKline' manager of communications, wrote in an email.

In a statement to CBC Toronto, Health Canada said it will "follow up" with the four companies to assess the impact their shortages could have on national supply of amoxicillin.

"Should Health Canada become aware of any supply concerns in Canada, it will take action," the statement said.

Alternative antibiotics can be used when amoxicillin is not available. Belcher says this often requires the pharmacist to communicate with the prescribing physician.

"All of this takes time and in some of these infectious disease scenarios with parents presenting with a sick child, there is that level of urgency."

Belcher says something that could improve these delays would be to grant pharmacists advanced prescribing authorization, which is available in other jurisdictions, such as Alberta, but not in Ontario.

She says it would allow pharmacists to prescribe an alternative to amoxicillin without having to communicate with the patient's doctor.