Daily Briefing

As the 'tripledemic' rages, demand for common children's medications is surging


Amid a "tripledemic" of Covid-19, influenza, and respiratory syncytial virus (RSV), health systems and pharmacies are experiencing a shortage of common antibiotics and antiviral drugs, such as Children's Tylenol.

The US is experiencing drug shortages

Around the United States, demand for antibiotics, antivirals, and pediatric cold and flu medications has increased in response to high rates of Covid-19, influenza, and RSV, making it difficult for patients, health systems, and pharmacists to obtain the drugs.

Recently, manufacturers of antibiotics, including Hikma Pharmaceuticals, Teva Pharmaceuticals, and Sandoz, reported shortages of these drugs, citing an unexpected increase in demand due to the early surge of respiratory illnesses, which continues to worsen.

According to Sarah Ash Combs, an ED physician at Children's National Hospital, health care providers are currently "seeing the knock-on effect," of these shortages. "Basically amoxicillin went on shortage so we upped our game and went to augmentin ... and that's now becoming on shortage," she said

"That definitely affects us in the emergency department because these are the types of things we prescribe for kids to go home with and we get calls ... with the parent saying: 'I'm at my third pharmacy and they don't have amoxicillin. They don't have augmentin. What do I do?'" Combs added.

Earlier this month, The University of Utah's Drug Information Service, which tracks drug shortages, received its first notification of a shortage of liquid ibuprofen, which is typically used for children, and confirmed it with manufacturers.

Last week, doctors at Intermountain Healthcare said pharmacists are attempting to reformulate adult doses of antivirals to help address shortages of Children's Tylenol.

In Florida, Harni Patel, a pharmacist and owner of Tamarac Pharmacy, said parents have been expressing concern over the difficulties they face looking for medications like Children's Tylenol, amoxicillin, and Tamiflu.

Amid the increase of infections and the shortages of children's medications, the University of Kansas Health System issued a warning to advise parents not to try to give children smaller doses of adult versions of the drugs.

The shortage is "a huge problem" according to Kristina Powell, a pediatrician and president of the Virginia chapter of the American Academy of Pedaitrics. "This is a result of the 'triple-demic.' Parents run to Walmart or Target, the shelves are empty … This is going to be a long fall and winter of viral infections."

As a result of the shortages, CVS and Walgreens on Monday announced they will limit purchases of children's pain relief medicine. Kroger also announced it will limit customers to purchasing two pediatric pain medications and four cold and flu items at a time, and Rite Aid is restricting online purchases of its 4 oz. grape-flavored Children's Tylenol to five units per customer—but it does not have any purchasing limits in-store.

According to a statement from CVS, the limits were put in place to "ensure equitable access" to the drugs for all customers.

"Due to increased demand and various supplier challenges, over-the-counter pediatric fever reducing products are seeing constraint across the country," Walgreens said in a statement, adding the limits were placed "in an effort to help support availability and avoid excess purchases."

What is driving the drug shortages?

According to former FDA commissioner Scott Gottlieb, the shortage is the result of an unexpected surge in demand for antibiotic and antiviral drugs—not supply chain problems.

On Sunday, Gottlieb said that distributors based their 2022 supply estimates on the lower demand seen during the past two years, which resulted from lower transmission due to additional prevention measures used during the Covid-19 pandemic.

"Demand went up this year, they anticipated some increase in demand, but not as much as we're seeing and not this early in the season," Gottlieb said. "So it's not any kind of disruption in supply. This isn't like what we had with baby formula where manufacturers have been taken out of the market."

"[Manufacturers] just didn't anticipate this much demand this early in the season," he added.

Gottlieb, who is a board member at Pfizer, said the pharmaceutical industry operates with a "sophisticated supply chain" and should be able to meet the increased demand soon.

"Supply should catch up with demand and there are alternatives for things that are in shortage," he said.

The Consumer Healthcare Products Association (CHPA), which represents three major manufacturers of children's pain and fever medications—Johnson & Johnson, Haleon, and Perrigo—said its members "don't have a timeline" for when supply will catch up to demand.

CHPA emphasized that "there is not a widespread shortage" of these drugs and that manufacturers are working around the clock to replenish supplies.

Erin Fox, director of the University of Utah's Drug Information Service, said, "These shortages seem to be mostly a demand spike and should resolve relatively quickly." (Reed, Axios, 12/19; Dress, The Hill, 12/19; McPhillips, CNN, 12/20; Tumin, New York Times, 12/20; Gibson, CBS News, 12/20)

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