child rsv rise
Pediatrician explains when children with RSV need to be taken to the hospital
01:48 - Source: CNN
CNN  — 

Shortages of key medications used to treat common childhood illnesses like flu, ear infections and sore throats are adding to the misery of this year’s early and severe respiratory virus season.

“Right now, we are having severe shortages of medications. There’s no Tamiflu for children. There’s barely any Tamiflu for adults. And this is brand-name and generic,” said Renae Kraft, a relief pharmacist in Oklahoma City. Additionally, “as far as antibiotics go, there’s not a whole lot.”

Kraft often works in rural areas of the state, floating between pharmacies when extra help is needed. On Monday, she worked in Holdenville, where there are two pharmacies: Pruett’s and Walmart. The same wholesaler stocks both stores, so if one pharmacy is out, the other usually is, too.

Kraft estimates that she had 20 people come in to Pruett’s to fill prescriptions for Tamiflu on Monday, but she didn’t have any, so she sent them to Walmart, which still had some.

On social media, families say they’ve hunted for hours for oseltamivir, the generic version of Tamiflu, and the first-line antibiotics amoxicillin and Augmentin. Inhalers of the drug albuterol, which is used to open airways in the lungs, are also in short supply, according to the American Society of Health-System Pharmacists, which maintains a list of drug shortages.

Anyone can report a shortage for the society’s list, and pharmacists from the University of Utah verify the information with drug manufacturers.

“In my 25 years of being a pediatrician, I’ve never seen anything like this,” said pediatric infectious disease specialist Dr. Stacene Maroushek of Hennepin Healthcare in Minnesota. “I have seen families who just aren’t getting a break. They have one viral illness after another. And now there’s the secondary effect of ear infections and pneumonia that are prompting amoxicillin shortages.”

Respiratory viruses hit hard

The cause of these shortages doesn’t seem to be a manufacturing problem, says Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists.

“It’s just increased demand ahead of schedule and higher than usual,” he said.

According to the US Centers for Disease Control and Prevention, more than half of US states have “high” or “very high” respiratory virus activity. Most of that is due to influenza, which hit early and hard this year. Respiratory syncytial virus, or RSV, is also playing a role. Nationwide, about 1 out of 5 tests for RSV was positive last week, a rate much higher than any point over the past two years.

There have been about 8 flu hospitalizations for every 100,000 people this season, rates typically seen in December or January. The cumulative hospitalization rate hasn’t been this high at this point in the season in more than a decade.

Prescription fills for the antiviral Tamiflu are at a 10-year high for this time of year, according to GoodRx.com, a company that helps people find discounts for prescription drugs.

People in the US are six times more likely to be taking Tamiflu at this point in the flu season as during the winter of 2019-20, which the next highest year.

As for the antibiotics amoxicillin and Augmentin – a combination of amoxicillin and clavulanate, an agent that helps guard against antibiotic resistance – it’s not entirely clear why demand is so high.

The CDC considers these to be first-line therapies for many common childhood ailments, like ear and sinus and throat infections.

Some viral illness, like influenza, can leave the body more vulnerable to secondary bacterial infections that may need treatment with antibiotics.

But these antibiotics have also been prescribed inappropriately when a child’s illness is really caused by a virus. Antibiotics kill bacteria, but they don’t do anything to fight viral illnesses.

“Anytime respiratory viruses kick up, people start prescribing antibiotics, even inappropriately, and that’s created a lot of demand. That wasn’t anticipated by the manufacturers of amoxicillin, so that’s led to shortages,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Companies work to resolve shortages

Pharmaceutical companies that make generic drugs don’t usually keep stocks of those medications on shelves. Instead, they manufacture medicines based on orders placed earlier in the year. This year’s orders didn’t anticipate the heavy season for respiratory illnesses, some manufacturers said.

In response, they are ramping up production, but it will take some time to get more product in stock.

Drug manufacturer Teva says it anticipates that some concentrations of amoxicillin that are on back ord