'triple threat' of viruses causing major shortage of kids' medication
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health canada is urging parents not to stockpile kids' medications or give children adult drugs without medical consultation. getty
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as many parents were already struggling with the major shortage of children’s pain medication, health canada has announced another distressing shortage — this time of an antibiotic commonly used to treat children’s infections.
on monday, health canada announced that four pharmaceutical companies have reported shortages of drugs containing amoxicillin, specifically in the liquid and chewable forms usually prescribed to children. the antibiotic agent is used to treat certain many bacterial infections, and is one of the most commonly-prescribed antibiotic drugs. this comes amid an existing shortage of childrens’ pain medication that contain acetaminophen (tylenol, tempra) and ibuprofen (advil, motrin) that’s been ongoing since the summer.
“not having a product to treat a fever itself will affect a large part of the larger childhood population because we’re seeing it across the country. we’re seeing it in all cities,” said barry power, editor-in-chief at the canadian pharmacists association (cpha) and a pharmacist in ottawa, told global news.
the situation is reportedly already contributing to overcrowding in hospitals, as desperate parents try to get some relief for their sick children. the shortage is coming at a time when the prevalence of several different illnesses is starting to converge, says jen belcher, vice president of the ontario pharmacists association.
“we were originally predicting a bit of a ‘twindemic’ this fall, and now we’ve got this triple threat with covid-19 circulating at relatively high levels, influenza season looking to shape up to be worse and earlier than an average year based off what we’ve seen out of the southern hemisphere and the united states, and then high levels of rsv [respiratory syncytial virus] circulating all of these viral illnesses,” she says.
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what makes kids’ pain medications different from adults’?
ibuprofen and acetaminophen for kids are common staples at most family homes, used for everything from teething to headaches to sore throats. they’re also commonly given to relieve fevers, muscle aches, and other common symptoms in children with covid, rsv or the flu.
acetaminophen and similar drugs for children are different from the adult versions in several ways, belcher explains. medicines for adults are usually in capsule form, but those are difficult for most kids to swallow, and obviously aren’t an option for a teething baby, for instance. medications for kids are usually formulated as chewable tablets, or as an oral liquid, and dosage is usually less for children than for adults.
those same factors are true with antibiotics, but one advantage to liquid amoxicillin is that the dosage can be given in specific increments, which offers more flexibility than a pill. this can be especially helpful for children, as how much given is often based on a child’s weight.
and while children are the primary patients taking antibiotics in liquid form, some adults do as well, belcher points out — particularly people with limited movement, like certain kinds of paralysis or those dealing with aspiration.
“unprecedented” demand and potential ingredient shortage
but given the “triple threat” of viruses — covid, the flu, and rsv — there’s a very high level of demand for pain meds that can decrease symptoms. it’s a need that health canada called “unprecedented” in a statement to healthing. the demand for antibiotics isn’t surprising either, belcher says.
“when you have high levels of circulating viral respiratory illness, you also will see an increase in the number of secondary bacterial infections,” she explains. “so while the antibiotic doesn’t treat the virus, what you may see is, after influenza people might get bacterial pneumonia. or after a really nasty cold or virus, you might see people with sinus infections or ear infections that could require antibiotic use.”
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beyond high demand, it’s still not totally understood what’s causing the shortage at the supply chain level. belcher says it’s conceivable that canadian manufacturers are dealing with a shortage of certain ingredients — “anything from the actual active pharmaceutical ingredient through to things like flavourings, additives, suspending agents, excipients” — that are sourced from overseas, although that’s just a guess.
the canadian pediatric society, though, says that the shortage is not due to any manufacturing or safety issues, and several drug manufacturers have said they’ve increased output of these specific medications. in fact, drug manufacturer glaxosmithkline told cbc news that its antibiotic shortage could be over by the end of november or early december, while other companies reporting shortages are projecting that product may become available anywhere from january to march of 2023.
why does canada have a shortage, but not the u.s.?
a major topic of discussion, though, is why canada is facing this shortage when other countries — notably, the u.s. and australia, from which health canada is sourcing medication — are not.
there’s an easy answer when it comes to australia, belcher says: the seasons are the opposite of ours, so while canada is entering the flu and virus season in the fall, australia is beginning its spring. as for the united states, belcher isn’t completely clear on how it has avoided a shortage, other than the fact that it may have more manufacturing capabilities that allow companies to produce more product in advance of a projected shortage.
in order to ease the impact of the shortage, health canada has approved the “exceptional importation” of ibuprofen from the u.s. and acetaminophen from australia for distribution in hospitals. american ibuprofen has already arrived, health canada told healthing, and its use in hospitals “is expected to be soon,” the agency says.
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usually products meant to be sold in countries outside of canada can’t be distributed in canadian stores, due to their unilingual labeling. canada’s consumer packaging and labelling act, established in 1985, promotes bilingualism by requiring that consumer products display information equally in both of canada’s official languages, english and french.
but, as is the case with the current medication shortage, exceptions are sometimes made.
a similar step was taken in may 2020, a number of conservative mps pointed out in a letter to health minister jean-yves duclos in late october, urging the liberal government to begin importing foreign-language children’s ibuprofen and acetaminophen for sale. during the early months of the pandemic, health canada made an exception allowing the sale of salbutamol aldo-union inhalers labeled in spanish due to a canadian shortage, for instance. the agency ended up allowing over 300 disinfectants and hand sanitizing products devoid of bilingual labels under an interim order made for the exceptional circumstances. at the time, the move was criticized by groups including the federation of francophone and acadian communities and the quebec federation of labour.
in this case, if canada does end up importing foreign drugs for consumer sales, “work will be done in partnership with providers to add information in both official languages,” health canada said.
what parents can do
pharmacists and family doctors are an important resource for worried parents. sometimes pharmacies or doctors’ offices keep extra stores of medications behind their counters in case of this kind of shortage, pharmacist dr. nardine nakhla told ctv news. and in many cases, pharmacists can also provide alternative medications, according to belcher.
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in some cases, depending on the child’s illness, pharmacists can make a children’s dose in a capsule using an adult formulation, she says, which a parent can then open and sprinkle onto food if their child can’t swallow a pill. in ontario, for example, pharmacists have the authority to adapt the doses and formulations of a prescription without going back to the doctor. pharmacists in alberta have even more autonomy — independently switching out amoxicillin for another antibiotic. in other provinces, pharmacists can speak with the prescriber and come up with alternatives. and pharmacies that offer compounding services may be able to compound liquid amoxicillin themselves.
health canada is also urging parents not to stockpile these drugs or give children adult drugs without consulting with a pharmacist or their doctor or use expired medication.
“it’s a really challenging time for parents, and it’s a challenging time to be accessing the health-care system and to have a sick child. we are here to help,” belcher says of pharmacists. “if you have questions and you’re feeling nervous, sometimes even just having a bit of information in advance allows you to feel a little bit more secure and prepared to help manage an illness in your child and to know what to do.”
she also urges parents and health professionals to be kind to one another.
“these shortages are frustrating for providers, too,” she says. “many of us are parents, and we have a lot of empathy.”
maija kappler is a reporter and editor at healthing.
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