After Adderall, common antibiotic amoxicillin runs into shortage amid demand spikes and manufacturing woes

Oral versions of the common antibiotic amoxicillin—often used on the front lines of childhood bacterial infections—are running scarce in the U.S., as the Halloween season dovetails with a surge in respiratory infections, notably in children, who could need the drug for secondary bacterial pneumonia infections. 

Following earlier reports of supply constraints from generics juggernauts like Hikma Pharmaceuticals, Teva Pharmaceutical and Novartis’ Sandoz unit, the U.S. Food and Drug Administration on Friday warned that amoxicillin oral solution—the liquid form of the drug often given to children—is currently in shortage. The agency said on its online drug shortage database that supplies from multiple drugmakers are “on allocation” amid a period of heightened demand.

That means products from Sandoz and fellow generics outfit Aurobindo are being distributed to limit sharing of scarce resources, according to the American Society of Health-System Pharmacists (ASHP). Allocation plans may include strategies to control the quantity and pace of product releases, among other measures, the organization explains on its website.

Hikma, Teva and Rising Pharma all report that they have multiple strengths of the antibiotic available on the FDA’s website, though each of the companies noted an increase in current amoxicillin demand.

The official FDA alert comes about a week after ASHP first sounded the alarm on an amoxicillin squeeze, singling out limited stocks from top suppliers Hikma, Teva and Sandoz.

Last week, Novartis told Bloomberg News it was facing “significant” demand for the common antibiotic in the U.S. and abroad.

“The combination in rapid succession of the pandemic impact and consequent demand swings, manufacturing capacity constraints, scarcity of raw materials, and the current energy crisis means we face a uniquely difficult situation in the short term,” a Sandoz spokesperson told the news outlet.

Teva didn’t respond to Bloomberg’s request for comment, while a Hikma spokesperson said as of last week the company was meeting all its orders nationally and had “adequate” supplies for its existing contracts.

As the FDA works with manufacturers to alleviate the supply crunch, Canada and Australia have also reported amoxicillin inventory woes, Bloomberg pointed out. CNN has flagged shortages in countries like Romania and Malaysia, too.

A recent surge in pediatric RSV cases may be to blame for the spike in antibiotic demand, U.S. News & World Report recently speculated. Amoxicillin isn’t used to treat the virus directly, but it is often given to kids to fight secondary bacterial infections. Influenza is also making a seasonally early comeback after a dormant few years, another infection that can require the drug if a secondary infection strikes. 

Amoxicillin isn’t the only drug running short at the moment, as the U.S. grapples with a seemingly ever-expanding shortage of the widely-used attention deficit hyperactivity disorder drug Adderall. Camber and Sun Pharma recently joined the roster of drugmakers reporting problems with their Adderall supply, following similar reports from companies like Sandoz and Teva.

Part of the problem stems from the fact that Adderall is classified as a Schedule 2 controlled substance—given its potential for abuse—which means companies are limited on how much they can make. This can lead to a ripple effect when shortages arise.

Further complicating the matter, demand for ADHD medications has spiked, owing to increased awareness of the condition, as well as the emergence of online startups that have made it easier to acquire prescriptions.