A study of US pediatric hospitals found that the 2022 amoxicillin shortage resulted in an increase in broad-spectrum antibiotic use, researchers reported today in the Journal of the Pediatric Infectious Diseases Society.

For the study, a team led by researchers from Lurie Children's Hospital of Chicago evaluated changes in antibiotic use at seven US tertiary care hospitals from July 24, 2022, to April 1, 2023. They wanted to see how antibiotic use in children who presented to the emergency department (ED) with symptoms of acute otitis media (AOM; ear infection), pharyngitis, or community-acquired pneumonia (CAP) changed after the US Food and Drug Administration declared a shortage of amoxicillin powder for liquid suspension on October 8, 2022. They defined amoxicillin as narrow-spectrum and amoxicillin/clavulanic acid, cephalexin, azithromycin, clindamycin, and cefdinir as broad-spectrum.

Of the 730,400 pediatric ED encounters, one of the study antibiotics was prescribed in 141,380 (19.3%). Of these, 19,045 (13%), 53,633 (38%), and 6,418 (5%) had diagnoses of pharyngitis, AOM, and CAP, respectively. Among encounters that involved prescribing at least one antibiotic, amoxicillin suspension prescribing significantly increased in the weeks leading up to the FDA announcement, then immediately fell by 30.8%. 

While use of amoxicillin non-suspension (which was not impacted by the shortage) increased by 7.9%, the FDA declaration was also associated with increased use of amoxicillin-clavulanic acid (+13.7%), cephalexin (+3.4%), azithromycin (+0.7%), and cefdinir (+6.4%). 

Concerns about antibiotic resistance

"Our findings support the hypothesis that clinicians adapted to the antibiotic shortage by prescribing second-line, often broader-spectrum, antibiotics for common infections," the study authors wrote. "While adaptability is a crucial strategy for future drug shortages, it raises concerns about antibiotic resistance from inappropriate use of broad-spectrum antibiotics and treatment failure from resultant antibiotic selection, particularly if future shortages are longer or more frequent."

The authors add, however, that they also found a decline in overall antibiotic prescribing during the study period, suggesting there may have been a greater reliance on non-antibiotic treatment strategies. 

"These findings underscore the need for systemic strategies, such as improved manufacturing capacity, international collaboration, and centralized guidance, to manage future drug shortages while maintaining antimicrobial stewardship," they concluded.

Over the past week, 147 more cases were reported in an unexplained outbreak in a remote region of the Democratic Republic of the Congo (DRC), according to the latest data today from the Africa Centres for Disease Control and Prevention (Africa CDC).

At a weekly briefing, Africa CDC Director Jean Kaseya, MD, MPH, said cases are up from 111 reported during the previous week. "This means we have a major public health issue in the DRC," he said. Nearly 42% of the cases have been reported in children younger than 5 years old.

One more death was reported in the previous week, which involved a child younger than 5 years. So far, 32 deaths have been documented at healthcare facilities, and investigations are under way to determine if 44 deaths reported at the community level are related to the outbreak. 

Though malaria was reported in some of the initial samples, the lab investigation into the cause or causes of the outbreak is far from complete, facing difficult obstacles in getting samples to the National Institute for Biomedical Research (INRB) in Kinshasa for testing.

More samples on their way to lab in Kinshasa

An official from the lab told Africa CDC that samples it received on December 7 are poor quality, with blood and serum samples poorly preserved and some showing hemolysis. The lab didn't receive any nasopharyngeal samples.

Kaseya said a team went back to Panzi health zone to collect more samples, which took 3 days due the remote location and difficult road conditions.

Dieudonne Mwamba, MD, PhD, director-general of the National Institute of Public Health within the DRC's health ministry, said the team collected 78 more samples, which includes several types. They are on their way to the lab in Kinshasa. He said officials anticipate more definitive results sometime over the next week.

Africa saw a notable jump in mpox cases last week, with a continuing rise in novel clade 1b detections and shifts in transmission status in affected countries, the head of the Africa Centres for Disease Control and Prevention (Africa CDC) said today at a weekly briefing.

Jean Kaseya, MD, MPH, the agency's director, said 3,545 cases were reported last week, up from 2,708 the previous week. Most were from the Democratic Republic of the Congo (DRC), the outbreak's epicenter. Thirty-seven new deaths were reported, similar to the 36 reported the week before.

The outbreaks, which have affected 20 African countries, are driven by clade 1a and the novel clade 1b virus. Kaseya said detections of clade 1b have been steadily rising since the middle of July.

Activity continues to fluctuate, with two countries with controlled transmission—the Republic of Congo and Ghana—returning to active transmission status. Meanwhile, six countries have shifted from active to the controlled stage: Gabon, Guinea, South Africa, Morocco, Zambia, and Zimbabwe.

Angola, one of the recently affected countries, has now recorded nine cases over the past 3 weeks. Cases are from two northwestern provinces, Luanda and Uige. Kaseya said sequencing is under way to determine the clade.

DRC to receive LC16 vaccine from Japan

In other developments, Dieudonne Mwamba, MD, PhD, director-general of the National Institute of Public Health within the DRC's health ministry, said the first doses of the LC16 vaccine donated by Japan are expected to arrive in the DRC next week. Japan had earlier announced a donation of about 3 million doses of the vaccine from its stockpile, along with a supply of bifurcated needles used to administer the vaccine. Mwamba added that, as part of the delivery, healthcare workers will be trained on how to use the bifurcated needles.

Arrival of the vaccine will fill a gap in vaccinating young children, given that it can be used on children as young as 1 year old. The Bavarian Nordic vaccine, already in use in the DRC, Rwanda, and Nigeria, is indicated only for people ages 12 and older, though a safety and immunogenicity study is under way in children ages 2 to 12 years old.