RDaniel12 / iStock 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.

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RDaniel12 / iStock 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 […]

Stethoscope with pill bottles — RDaniel12 / iStock

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.