Downing a spoonful of bubblegum pink amoxicillin is a regular part of being a kid, but a nationwide shortage of the antibiotic is making a particularly bad season of strep throat tougher.

That hit home for Caitlin Rivers recently when both of her kids had strep.

"We had to visit several pharmacies to find the medication that we needed," says Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. "It just adds another burden on what's already been a really difficult winter respiratory season for families."

A spike in strep

Strep, short for Streptococcus, can cause a bacterial infection that typically leads to a sore throat, fever and swollen tonsils. It can affect adults, but it's most common in school-aged children.

Because the Centers for Disease Control and Prevention doesn't closely track run-of-the-mill strep infections, it's unclear just how many cases there are in the U.S. right now. But Rivers says strep activity has been higher in the last few months compared to previous years.

"This whole winter season has been really tough for the common pathogens that keep us out of school and out of work," says Rivers. "And strep throat is the one that has really been going around."

The CDC is tracking an especially nasty kind of strep, called invasive group A strep.

Invasive strep means that instead of the bacteria staying in the throat, it spreads to other parts of the body, Rivers says. The bacteria can get into the bloodstream or cause a rash on the skin, for instance.

And after two years of record low cases of invasive strep during the height of the pandemic in 2020 and 2021, cases are higher than usual this season, according to the CDC.

Regardless of what kind of strep someone has, strep infections need to be treated with antibiotics.

Shortage of the 'pink stuff'

The Food and Drug Administration added amoxicillin products to its list of drug shortages in October of last year and some still aren't available.

The current shortage is limited to pediatric versions of amoxicillin, which are liquid products that are easier for kids to take than pills.

The shortage is affecting multiple generic brands, like Sandoz and Teva, but not every amoxicillin product or strength they make.

Erin Fox, a national expert on drug shortages at the University of Utah, says a really popular strength of amoxicillin – 400 mg/5mL – isn't always available, but pharmacists have other options.

"You might need to switch," she says. "So you might have to take a little bit more volume... I have given children antibiotics, and I know that that's not fun, but you can do that."

She says parents may need to call around if their pharmacy doesn't have what they need. But since amoxicillin isn't a controlled substance, pharmacists should be able to get and share information on which other pharmacies have it in stock.

Too much demand

The shortage appears to be caused by a demand issue rather than a quality issue. In other words, there are more people who need the drug than what's available.

"Companies typically look to see what their sales were the prior year. They might make a little bit of an adjustment," Fox says. "But with the really severe respiratory season we've had this year, it just simply was a mismatch between what people manufactured and what was available."

However, under current rules and regulations, drugmakers don't actually have to tell the public the reason why something is in shortage. Not all of them have explained themselves, but based on what a few companies have told the FDA, it doesn't seem to be a problem with the manufacturing of the drug – for example, contamination at the plant.

Fox says this means drugmakers can hopefully get the forecast right for next year and make enough. And luckily, similar to other respiratory illnesses, strep usually peaks between December and April, so it could be the tail end of this year's season.

Though epidemiologist Rivers points out that the pandemic has thrown off the regular pattern of winter illnesses.

"So I can't be confident that April will mark the end of this strep throat season," she says, adding that the amoxicillin shortage may continue to cause trouble.

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