Antibiotic shortage still a worry, Alberta doctors and pharmacists say

A shortage of antibiotics that has dragged on for months continues to make it difficult for Alberta parents to find treatment for their sick children.

Eight drug companies are reporting shortages of different forms of amoxicillin due to increased demand or manufacturing disruptions, according to the Drug Shortages Canada database.

Amoxicillin is commonly used to treat a wide range of conditions, including ear infections, strep throat and pneumonia.

"It's been very difficult when parents come in very worried and they've been to two or three pharmacies and no one has it," said Randy Howden, a Calgary pharmacist and owner of the Sunridge and Crowfoot locations of The Medicine Shoppe.

Compounding pharmacies like his have been making amoxicillin suspension for children when there's no stock available.

According to Howden, while shelves were entirely empty at the end of 2022, pharmacies are now able to order small amounts of amoxicillin from time to time.

"Today, I was able to order four bottles.… It's not a huge amount at all. It might be enough to get us through the next day if we're lucky."

Health Canada designated the oral suspension form of amoxicillin as a "Tier 3" shortage in November. That label is reserved for shortages that have the greatest potential to impact the national drug supply and the health-care system.

Treatment difficult

Because amoxicillin is a broad spectrum antibiotic, used to treat a variety of childhood infections, the shortage is making pediatric treatment problematic.

"It's impacting our ability to treat the younger kids who can't take pills. And that's the problem because [it] is still a primary pediatric antibiotic that we use for a lot of infections," said Dr. Sam Wong, an Edmonton-based pediatrician and section president of pediatrics with the Alberta Medical Association.

It's particularly difficult, he said, during a winter with high rates of infections among children.

"We're struggling … to try and deal with these increased number of pediatric patients who have infections. And, as a result, we're having difficulties getting antibiotics and finding second-line choices to deal with it."

According to Wong, while there are alternatives doctors can prescribe, they aren't always ideal.

"There are other options but they may be less palatable or more difficult to give or they need more frequent dosing."

Some second- or third-line drugs, he said, are normally kept for more serious infections or those that don't respond to amoxicillin.

"There's always a risk of using these antibiotics, because you have the potential to increase antibiotic resistance. So that's the biggest fear," Wong said.

Other antibiotics in short supply

At Lukes Drug Mart, in Calgary's Bridgeland neighbourhood, pharmacy manager David Brewerton said while the supply of amoxicillin has improved in recent weeks, levels aren't even close to normal.

"Back to where we were before? No. But it is improving. There is some squeaking through the system," he said.

According to Brewerton, the shortage is spilling over now and impacting other antibiotics commonly used for kids.

"Any other antibiotic suspension pretty much is iffy at this point because they were never as common. So there isn't as much in the supply chain," he said.

"It hasn't taken much to wipe them out.… [It's] the domino effect," he said.

According to the Health Canada website, Cefprozil, Cefuroxime, Cephalexin, Azithromycin and Clarithromycin oral -suspension formulations were designated as Tier 3 shortages in early December.