Anti Viral Tablets

In children, the stress of viral illness is compounded by a lack of antivirals and antibiotics

This year’s severe and early respiratory virus season is being exacerbated by a shortage of essential medications that are used to treat common childhood ailments like sore throats, ear infections, and flu.

“Right now we are experiencing severe shortages in medications. Children can’t use Tamiflu. Adults have very little Tamiflu. This is brand-name as well as generic,” Renae Kraft, an Oklahoma City relief pharmacist, said. There are not many antibiotics available.

Kraft is often found in rural areas of the state and can be seen hopping between pharmacies when needed. Monday saw Kraft working in Holdenville where there are two pharmacies, Pruett’s and Walmart. Both pharmacies are stockists of the same wholesaler, so if one is closed, the other is usually open.

Kraft estimated that 20 people came into Pruett’s on Monday to get Tamiflu prescriptions. But she didn’t have any Tamiflu so she sent them to Walmart.

Social media users have shared stories of families who claim they have searched for Tamiflu, as well as the first-line antibiotics Amoxicillin and Augmentin for hours. According to the American Society of Health-System Pharmacists (which maintains a list of drug shortages), inhalers of albuterol, which opens the airways in the lungs to allow for breathing, are also in limited supply.

Anybody can report a shortage to society’s mailing list. University of Utah pharmacists verify the information with drug companies.

“I’ve never seen anything similar in my 25 years as a pediatrician,” Dr. Stacene Marshek, a Minnesota pediatric infectious disease specialist at Hennepin Healthcare. “I’ve seen families that are just not getting a break. They are suffering from one virus after another. The secondary effects of ear infections, pneumonia, and amoxicillin shortages are also present.”

Respiratory viruses can be very severe

According to Michael Ganio (senior director of pharmacy practice quality and quality at the American Society of Health-System Pharmacists), there is no manufacturing problem that could be responsible for these shortages.

He said, “It’s just an increased demand ahead of time and higher than usual.”

The US Centers for Disease Control and Prevention reports that more than half of US states are affected by high or very high levels of respiratory virus activity. Influenza, which struck early and severely this year, is most of the reason. The role of respiratory syncytial virus, also known as RSV, is also being played. Nationally, approximately 1 in 5 RSV tests were positive last week. This is a much higher rate than at any other point over the past 2 years.

For every 100,000 people, there have been 8 flu hospitalizations this season. These rates are usually seen in December and January. This season, the cumulative hospitalization rate is at its lowest point in more than 10 years.

According to GoodRx.com (a company that assists people in finding discounts on prescription drugs), prescription fills for antiviral Tamiflu have reached a 10-year peak for this time of the year.

The flu season is six times longer in the US than in winter 2019-20. This is the next highest year.

It’s unclear why there is such high demand for antibiotics Augmentin and amoxicillin – a combination of amoxicillin/clavulanate that helps protect against antibiotic resistance.

These are first-line treatments for common childhood conditions, such as ear, sinus, and throat infections.

A viral illness like influenza can make the body more susceptible to secondary bacterial infections, which may require antibiotic treatment.

These antibiotics can also be prescribed incorrectly if a child has a serious illness that is caused by a virus. Although antibiotics kill bacteria, they do not fight viral infections.

“Whenever respiratory viruses are active, people prescribe antibiotics. This has created a lot of demand. This was not anticipated by amoxicillin manufacturers, which has led to shortages,” Dr. Amesh Adalja, a senior scholar from the Johns Hopkins Center for Health Security, said.

Companies resolve shortages

Generic drugs are not kept on shelves by pharmaceutical companies. They instead make medicines based upon orders placed earlier in each year. Some manufacturers claimed that this year’s orders did not anticipate the severe season for respiratory illness.

They responded by increasing production but will need to wait for more products to be in stock.

Teva, a drug manufacturer, says that it expects some amoxicillin concentrations on back order will be back in stock beginning in December and continuing through February.

Sandoz, which also produces generic amoxicillin said the shortage was caused by many factors. The company released a statement saying that the shortage was caused by a combination of rapid demand swings and pandemic effects, as well as manufacturing capacity constraints and scarcity of raw materials.

Hikma, another manufacturer of amoxicillin, stated that it has sufficient supplies to fulfill orders and is managing its supply so that all orders are fulfilled.

A spokesperson for the company stated that they understand the importance and are exploring ways to increase its production.

The US Food and Drug Administration took steps to assist with the shortage by releasing guidance to pharmacists on how to make liquid amoxicillin for children from pills. Ganio stated that amoxicillin pills for adults do not run out.

Advice for parents

Parents should not be alarmed by the news of shortages. Brigid Groves is a pharmacist who serves as the senior director for professional and practice affairs at the American Pharmacists Association.

She said that the most important thing a family can do for a sick relative is to get them tested. Many doctors’ offices and pharmacies can quickly test for a viral or bacterial illness.

Groves stated that we don’t want an antibiotic to be used on someone with Covid because it is not

going to work. We also run the risk that we create more resistance to our existing bacterial antimicrobial agent.”

Pew Charitable Trusts’ recent study found that 30% of children’s outpatient prescriptions for antibiotics were not appropriate. This could be because the medication was prescribed to treat viral infections or because the recommended drug wasn’t used. The study also found that antibiotics can increase the risk of C. diff (a potentially life-threatening bacterial infection); allergic reactions; and skin eruptions.

Groves stated that it is important for a caregiver or family member to have their loved one evaluated to ensure that the right therapy is being given. It could be a viral infection or a bacterial condition. If the child is suffering from wheezing, it’s important to ensure that albuterol supportive care is provided.

Groves said that parents need to be aware of the fact that filling a child’s prescriptions for Tamiflu and amoxicillin may require some searching. They might have to travel further or visit a new store.

She said that if all the local pharmacies are closed, it might be possible to obtain a prescription for an antiviral or antibiotic alternative.

She said that there are many options for treating the same infection with different agents.

You may also be able to get the medication mixed by a compounding pharmacy.

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