AAP issues guidance on alternatives to in-shortage amoxicillin

Amid a shortage of the antibiotic amoxicillin, the American Academy of Pediatrics (AAP) has issued guidance on alternatives to the oral powder formulation for suspension in its Red Book Online.

The shortage, which is expected to last several months, is being fueled by increased demand as many US children are ill with respiratory diseases such as the flu, COVID-19, and respiratory syncytial virus (RSV), according to amoxicillin manufacturers reporting shortages to the US Food and Drug Administration (FDA). Though antibiotics aren't indicated for these viral illnesses, clinicians may prescribe them presumptively.

The AAP first urges clinicians not to prescribe antibiotics to patients with viral illnesses, because overprescribing can lead to antibiotic resistance. If antibiotics are indicated, pediatricians can use alternative amoxicillin formulations not in shortage (eg, tablets, capsules, chewable tablets), rounding doses to within 10% of 125, 250, 500, 750, 875, or 1,000 milligrams, the AAP said.

To use tablets in pediatric patients, clinicians can split or crush them, and they can open capsules and split chewable formulations and mix them with liquid or a semisolid such as applesauce to be given by mouth or tube.

If amoxicillin isn't available or can't be used in a patient owing to hypersensitivity, the guidance said, pediatricians can treat ear infections with amoxicillin/clavulanate or intramuscular ceftriaxone, community-acquired pneumonia or sinusitis with amoxicillin/clavulanate, and pharyngitis caused by group A Streptococcus with Penicillin VK, intramuscular penicillin G benzathine x 1, or cephalexin. Penicillin VK can be used for infection prevention after spleen removal.

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