The antiviral Tamiflu (oseltamivir) and some of its generic versions are in short supply, according to a list by the American Society of Health-System Pharmacists (ASHP). High demand has also impacted the accessibility of amoxicillin and Augmentin (amoxicillin and clavulanate), first-line antibiotics commonly prescribed for children with ear infections, bronchitis, and strep throat.
Anyone can report a drug shortage to the ASHP, and pharmacists from the University of Utah verify the reports with drug manufacturers.
Prescription fills for Tamiflu are far outpacing the 10-year average for this time last year, according to the healthcare company GoodRx.
Similarly, the pediatric versions of amoxicillin are nearly out of stock, said Michael Ganio, PharmD, senior director of pharmacy practice and quality at ASHP.
Pediatric hospitals already strained from the impact of the COVID-19 pandemic are now struggling to care for children sick with other respiratory viruses. More than 6% of outpatient visits are for flu last week—that’s three times the rate at the same time last year, according to the Centers for Disease Control and Prevention.
The flu season is just getting underway, but there are already 2.5 times as many cases as at the same time last year. And in the past month, about 17% of RSV tests were positive, compared to 7% at the same time last year.
“Classically, flu doesn’t peak until January or February. We’re not even there yet. We have no clue what’s going to happen with RSV because it’s not behaving like it ever has before,” Stanley Spinner, MD, Chief Medical Officer at Texas Children’s Pediatrics and Texas Children’s Urgent Care, told Verywell.
What Are Some Alternatives to Tamiflu?
Tamiflu can help decrease the duration and severity of flu symptoms for a day or two when given within two days of exposure or symptoms appearing. Spinner said that while it’s useful for alleviating symptoms in people at risk for more severe outcomes of flu, it’s not necessary for most healthy people.
“It’s important for parents to understand that just because your child has influenza doesn’t mean he or she needs to be on Tamiflu. Influenza is going to go away by itself,” Spinner said.
Spinner cautioned against giving children Tamiflu by opening a capsule intended for adult use. Taking an intact capsule is important for the controlled release of the drug. Children can take the tablet form of Tamiflu, so long as the dosage is adjusted and they are able to swallow it.
Other antivirals can be used in lieu of Tamiflu. Those alternatives, which include Relenza (zanamivir), Rapivab (peramivir), and Xofluza (baloxavir marboxil), appear to be available.
However, Xofluza is still on patent so caregivers may face insurance issues. Relenza requires a different inhalation technique and is not available in generic forms.
Why Is Amoxicillin Also in Shortage?
As with viral infections, bacterial infections become more common in colder months. These include strep throat and sinus and ear infections. Amoxicillin is an antibiotic, meaning it can be used to treat those common bacterial infections, but won’t be effective against viruses, like influenza and RSV.
Certain chewable and liquid forms of amoxicillin are currently the hardest to come by, Ganio said pharmacists are starting to see shortages in the adult forms as well.
The shortage of amoxicillin could be driven in part by inappropriate prescribing of the antibiotic. A study published earlier this year in JAMA Network Open found that 31% of outpatient prescription antibiotics for children were inappropriate.
When providers are overwhelmed with patients, they may prescribe antibiotics for a viral infection rather than take the time to explain the differences in treatments to patients, even though this is poor practice, Spinner said.
“There has always been parental pressure on physicians to prescribe antibiotics for kids when they have respiratory infections, even when they may be viral,” he said.
Getting an accurate diagnosis is important to ensuring that a sick individual is getting effective treatment.
“There’s often difficulty in making a diagnosis, particularly over the phone. Pediatricians and hospitals are being overwhelmed, so telemedicine might be the only option for a parent or caregiver to care for their child. And if that’s the case, it may be difficult to rule out a bacterial infection versus RSV or flu,” Ganio said.
But Ganio cautioned that there is no data directly matching prescriptions to diagnoses, so it’s hard to know if inappropriate prescribing is a significant driver of the current shortage.
Albuterol is a drug that can open up the airways, easing some of the symptoms of RSV and flu. There’s a shortage of the version that’s used in hospitals, but the self-administered inhaled version, which is given in outpatient settings, is still in ample supply.
How to Get Treatment and Stay Healthy This Season
The Food and Drug Administration said the shortages would likely last through the coming months.
All the same mitigation strategies that work to protect against COVID-19 will also work against other respiratory illnesses.
“The best thing you can do is to teach your children that washing your hands is incredibly important. It always has been,” Spinner said.
Avoiding crowded indoor spaces when possible, wearing a well-fitting mask, and getting tested at the first sign of illness can also reduce the risk of getting and sharing a virus. For caregivers of children, Spinner said to keep kids at home when they display signs of sickness and encourage them to stay hydrated when ill.
Patients who are having a hard time finding their typical medication can speak with a pharmacist or health provider to adjust the dosage of an available form of the drug or to find a suitable alternative.
The second best option, Ganio said, is to look for the medication at a different nearby pharmacy.
“There’s a shortage of pharmacy technicians and the pharmacy workforce is being strained right now,” Ganio said. “I know it’s not a great time if you’re a parent or caregiver of a sick child, but just try to be patient and work with the pharmacy and the provider to find that next best option, understanding that there are a lot of other priorities at the moment, too.”
