By Brenda Goodman and Raenu Charles, CNN
Shortages of key medications used to treat common childhood illnesses like flu, ear infections and sore throats are adding to the misery of this year’s early and severe respiratory virus season.
“Right now, we are having severe shortages of medications. There’s no Tamiflu for children. There’s barely any Tamiflu for adults. And this is brand-name and generic,” said Renae Kraft, a relief pharmacist in Oklahoma City. Additionally, “as far as antibiotics go, there’s not a whole lot.”
Kraft often works in rural areas of the state, floating between pharmacies when extra help is needed. On Monday, she worked in Holdenville, where there are two pharmacies: Pruett’s and Walmart. The same wholesaler stocks both stores, so if one pharmacy is out, the other usually is, too.
Kraft estimates that she had 20 people come in to Pruett’s to fill prescriptions for Tamiflu on Monday, but she didn’t have any, so she sent them to Walmart, which still had some.
On social media, families say they’ve hunted for hours for oseltamivir, the generic version of Tamiflu, and the first-line antibiotics amoxicillin and Augmentin. Inhalers of the drug albuterol, which is used to open airways in the lungs, are also in short supply, according to the American Society of Health-System Pharmacists, which maintains a list of drug shortages.
Anyone can report a shortage for the society’s list, and pharmacists from the University of Utah verify the information with drug manufacturers.
“In my 25 years of being a pediatrician, I’ve never seen anything like this,” said pediatric infectious disease specialist Dr. Stacene Maroushek of Hennepin Healthcare in Minnesota. “I have seen families who just aren’t getting a break. They have one viral illness after another. And now there’s the secondary effect of ear infections and pneumonia that are prompting amoxicillin shortages.”
Respiratory viruses hit hard
The cause of these shortages doesn’t seem to be a manufacturing problem, says Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists.
“It’s just increased demand ahead of schedule and higher than usual,” he said.
According to the US Centers for Disease Control and Prevention, more than half of US states have “high” or “very high” respiratory virus activity. Most of that is due to influenza, which hit early and hard this year. Respiratory syncytial virus, or RSV, is also playing a role. Nationwide, about 1 out of 5 tests for RSV was positive last week, a rate much higher than any point over the past two years.
There have been about 8 flu hospitalizations for every 100,000 people this season, rates typically seen in December or January. The cumulative hospitalization rate hasn’t been this high at this point in the season in more than a decade.
Prescription fills for the antiviral Tamiflu are at a 10-year high for this time of year, according to GoodRx.com, a company that helps people find discounts for prescription drugs.
People in the US are six times more likely to be taking Tamiflu at this point in the flu season as during the winter of 2019-20, which the next highest year.
As for the antibiotics amoxicillin and Augmentin — a combination of amoxicillin and clavulanate, an agent that helps guard against antibiotic resistance — it’s not entirely clear why demand is so high.
The CDC considers these to be first-line therapies for many common childhood ailments, like ear and sinus and throat infections.
Some viral illness, like influenza, can leave the body more vulnerable to secondary bacterial infections that may need treatment with antibiotics.
But these antibiotics have also been prescribed inappropriately when a child’s illness is really caused by a virus. Antibiotics kill bacteria, but they don’t do anything to fight viral illnesses.
“Anytime respiratory viruses kick up, people start prescribing antibiotics, even inappropriately, and that’s created a lot of demand. That wasn’t anticipated by the manufacturers of amoxicillin, so that’s led to shortages,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
Companies work to resolve shortages
Pharmaceutical companies that make generic drugs don’t usually keep stocks of those medications on shelves. Instead, they manufacture medicines based on orders placed earlier in the year. This year’s orders didn’t anticipate the heavy season for respiratory illnesses, some manufacturers said.
In response, they are ramping up production, but it will take some time to get more product in stock.
Drug manufacturer Teva says it anticipates that some concentrations of amoxicillin that are on back order will be back in stock starting in early December and continuing to the end of February.
Sandoz, which also manufactures generic amoxicillin, said that shortage had many factors. “The combination in rapid succession of the pandemic impact and consequent demand swings, manufacturing capacity constraints, scarcity of raw materials, and the current energy crisis means we currently face a uniquely difficult situation,” the company said in a statement.
Hikma, another amoxicillin maker, said it has adequate supplies to fill orders and is managing its supply to make sure all orders are filled.
“We understand the importance of this medication and are looking at ways to increase production,” a spokesperson said in a statement.
Genentech, which manufactures Tamiflu, says it has plenty of the name-brand antiviral medication available.
“We have sufficient supply to meet the demand and are continuously evaluating the need to increase production. Tamiflu is also widely available and there are multiple generic manufacturers of oseltamivir. There is sufficient supply of branded Tamiflu,” a company spokesperson said in a statement.
Other companies that manufacture amoxicillin and those that make generic versions of Tamiflu reported to be in shortage didn’t respond to CNN’s request for comment.
The US Food and Drug Administration has taken steps to help amid the shortage, putting out guidance to pharmacists for how to make liquid amoxicillin for children from pill versions. Amoxicillin pills for adults are not in short supply, Ganio said.
Advice for parents
Although news of these shortages may generate some anxiety, parents should be aware but not alarmed, said Brigid Groves, a pharmacist and the senior director for practice and professional affairs at the American Pharmacists Association.
The most important thing families can do for a sick loved one is to get them tested, she said. Most doctor’s offices and some pharmacy clinics can do rapid tests to help determine whether your symptoms are coming from a viral illness or a bacterial one.
“We don’t want to treat somebody that has Covid with an antibiotic, because it’s not going to be effective,” Groves said. “And then we also run the risk of creating more resistance in our current bacterial antimicrobial agents out there.”
A recent study by the Pew Charitable Trusts concluded that about 30% of outpatient prescriptions of antibiotics for children were inappropriate, either because the medications were given to treat viral illnesses or because the recommended agent wasn’t used. Additionally, the study found that antibiotics increase the risk of C. diff, a bacterial infection that can be life-threatening; allergic reactions; and skin rashes.
“It’s important that a family or caregiver has their loved one appropriately evaluated to assure that whatever they are being treated for, they will get the appropriate therapy,” Groves said. That may be a viral illness or a bacterial infection, or a condition that calls for medication like albuterol for supportive care, making sure that the drug is being used appropriately for children who are wheezing or having trouble breathing.
Groves also said parents should know that it may take some hunting to fill a child’s prescription for Tamiflu or amoxicillin. They may have to drive farther or go to a store they’re not familiar with.
If all stores in the area are out, she said, it may be possible to get a prescription for a different antibiotic or antiviral.
“There are options to treat the same infection with a different agent,” she said.
A compounding pharmacy may be able to mix the medication you need, too.
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CNN’s Deidre McPhillips and Nadia Kounang contributed to this report.