America's amoxicillin shortage

An ongoing nationwide shortage of a common antibiotic is exacerbating an abnormally tough strep throat season in the United States. Here's what you need to know about the amoxicillin shortage:

What is amoxicillin?

Amoxicillin is an antibiotic commonly used to treat various infections caused by bacteria, such as "tonsillitis, bronchitis, pneumonia, and infections of the ear, nose, throat, skin, or urinary tract," per Drugs.com. It is part of a group of medications known as "penicillin antibiotics" that work by "killing the bacteria and preventing their growth," according to the Mayo Clinic. The antibiotic does not, however, work for common colds, the flu, or other viral infections.

Amoxicillin can be prescribed in many ways, but children "generally take the liquid form of the drug, which is where most of the shortages are occurring," Bloomberg reports.

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What is causing the amoxicillin shortage?

The Food and Drug Administration added several amoxicillin products and dosages to the list of national drug shortages last October, and some are still unavailable in some pharmacies, NPR reports. "The current shortage is limited to pediatric versions of amoxicillin, which are liquid products that are easier for kids to take than pills." The shortage seems to be caused by the overwhelming demand for antibiotics rather than an issue with product quality. "In other words," NPR adds, " there are more people who need the drug than what's available."

Some companies say the demand for the drug plummeted during the pandemic, "when COVID-19 mitigation measures also lowered rates of other infections," CNN writes. And while drug manufacturers typically make their product when there is a demand for it, "they need time to catch up when demand increases. "Indeed, these companies "typically look to see what their sales were the prior year" and adjust their production accordingly, Erin Fox, a national expert on drug shortages at the University of Utah, told NPR. "But with the really severe respiratory season we've had this year, it just simply was a mismatch between what people manufactured and what was available," she said.

A spokesperson for generic drugmaker Sandoz, a division of Novartis AG, explained that the company was facing supply issues in the U.S. and other countries due to a "significant" surge in demand for amoxicillin. "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 face a uniquely difficult situation in the short term," spokesperson Leslie Pott told Bloomberg in October.

Last winter, the U.S. was battling a so-called "tripledemic" that included a surge in RSV, or respiratory syncytial virus, which most commonly affects kids. While doctors do not need amoxicillin to treat that viral infection, "some children can develop secondary bacterial infections that may require antibiotics," CNN explains.

How is the shortage affecting strep throat season?

While "bubblegum pink" amoxicillin is a typical treatment for infections like strep in children, the "nationwide shortage of the antibiotic is making a particularly bad season of strep throat tougher," NPR says. Strep, or Streptococcus, can cause "a sore throat, fever, and swollen tonsils." It typically affects school-aged children, typically between December and April. So while it is somewhat normal to see a surge in strep throat during this timeframe, experts have warned Today that the current wave is the worst it's been in a long time. Dr. Greg DeMuri, a pediatric infectious disease physician with UW Health Kids in Madison, Wisconsin, told Today that he hasn't seen it this bad in all of his 30-year career. "We are at a level twice that of our worst year, looking back over the past 10, 20 years or so."

The Centers for Disease Control and Prevention is tracking an increase in "an especially nasty kind of strep," called invasive group A strep, NPR reports. Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, says invasive strep can spread from the throat to other parts of the body. After record-low cases in 2020 and 2021, cases of invasive strep are higher than usual this season, per the CDC. "Regardless of what kind of strep someone has," NPR explains, "strep infections need to be treated with antibiotics."

The shortage became real for Rivers when both of her children were diagnosed with strep throat. "We had to visit several pharmacies to find the medication that we needed," she told NPR. "It just adds another burden on what's already been a really difficult winter respiratory season for families."