- Tylenol, amoxicillin, Tamiflu, and albuterol are all proving hard for some parents to find.
- Experts recommend asking your pharmacist if alternatives are available, like generics or capsules.
Pharmacists across the country are having a hard time keeping four common medicines on their shelves, as a big wave of winter illnesses overstretches their supplies of children's medications.
The four medicines, which can help reduce fevers, fight bacteria and viruses, and help patients breathe, are in short supply for a few different reasons.
They are:
- Amoxicillin (an antibiotic which treats bacterial infections)
- Tamiflu (an antiviral which fights the flu)
- Albuterol (a bronchodilator which helps treat and prevent difficulty breathing)
- Children's Tylenol (a pain reliever and fever reducer)
There are alternatives to amoxicillin, for those who really need it
CDC director Rochelle Walensky says she is urging doctors to prescribe antibiotics correctly this fall. The US Food and Drug Administration says liquid amoxicillin for kids will be in short supply until spring 2023 due to "demand increase." But that demand isn't always appropriate. Studies suggest around 30% of antibiotics are improperly prescribed — often for viruses that aren't treatable with antibiotics, like flu, COVID, and RSV.
There are kids out there who could really benefit from antibiotics, though. Strep throat, for example, which is one of the most common bacterial infections in the world, is back in rotation this fall after a couple years of low circulation during the pandemic.
Dr. Anthony Flores, chief of pediatric infectious diseases with Memorial Hermann Hospital and UTHealth Houston, told Insider that providers can perform rapid strep tests to confirm a patient's diagnosis. They should also look for the tell-tale sign that a patient is dealing with bacteria, not a virus: large, red, and pus-covered tonsils.
In that case, doctors like prescribing amoxicillin because "it's got a good flavor," Flores said. "Kids take it really easily."
While liquid amoxicillin may be hard to find, the American Society of Health-System Pharmacists, which keeps track of drug shortages, says that there is still a limited supply of some chewable and tablet versions of amoxicillin.
Doctors can prescribe capsules even for children who don't swallow pills yet, Dr. Sallie Permar, pediatrician-in-chief at NewYork-Presbyterian Komansky Children's Hospital, told Insider. In that case, caregivers can open the capsules up and feed kids the powder inside, Permar said.
There are other alternatives. One of Flores's favorite amoxicillin alternates is called Keflex (generic name: Cephalexin), but there are many more antibiotics to choose from which can treat a case of strep throat. Doctors will take into account various factors like a patient's allergies, so these prescriptions will "depend on the clinical scenario" at hand, he said.
For albuterol, Tylenol, and Tamiflu, experts recommend alternatives including generics and compounding
Dr. Permar said many of the "standard" medications used to treat pediatric respiratory illnesses are "increasingly difficult to find in stock" during this year's early wave of respiratory illnesses, which arrived before manufacturers were ready for steep increases in demand.
If you're having trouble finding children's Tylenol, try a generic version of the drug (called acetominophen) which works just as well, Permar said. Just make sure it's still a children's formulation — the adult dose of the drug will be too much for kids, and can be toxic to their livers.
Trained pharmacists might be able to compound adult drugs into formulations that are suitable for kids during a shortage, pharmacist Rima Arora, director of pharmacy at the online drugstore DiRx, suggested.
But "never try to do this yourself" pediatrician Joanna Dolgoff, spokeswoman for the American Academy of Pediatricians, told the Washington Post.
Neither the FDA nor the ASHP are reporting shortages of acetominophen, which means generic versions of Tylenol should be relatively easy to find.
If your typical albuterol prescription is tough to source, the American College of Allergy, Asthma and Immunology suggests asking your provider for an alternative. Or, you can even use an expired inhaler you might have at home, "as it is probably still at least partially effective" — that's what the ACAAI suggested in previous guidance, issued when albuterol was being used widely for COVID-19 breathing problems in early 2020.
According to the FDA and the ASHP, it's possible the albuterol shortage could last into the spring of 2023.
If you can't get Tamiflu for your kids, Arora says don't panic. "Viral infections in otherwise healthy patients can still be handled by rest and fluids," she said. The Tamiflu shortage is expected to subside relatively soon — by late December. In fact, the FDA doesn't even list oseltamivir (the generic name for Tamiflu) in any current shortage.
Finally, you can also also shop around at different pharmacies, as some may have in stock what others don't. Permar acknowledges that this can be a "time consuming" chore for busy parents, though, "therefore, knowing the alternative recommendations can be helpful," she said, like scouting out generics, or using powder instead of liquid.