Hospital amoxicillin supply not keeping up with surging demand
By Megan Headley
The twin surges in influenza and respiratory syncytial virus (RSV) across the United States are causing more than capacity issues for hospitals. Patients with RSV are often susceptible to bacterial infections that are, for pediatric patients, typically treated with amoxicillin. Yet in late October 2022, the FDA confirmed a shortage of amoxicillin oral powder for suspension due to increased demand.
Data from Vizient, a healthcare consultancy with supply chain services, showed a 43% surge in demand for amoxicillin products in the acute care setting from September to October 2022. In that same period, fill rates dropped by 25%. This data comes from purchases by Vizient members, which encompass more than 60% of the nation’s healthcare organizations.
“If we look at the demand from October 2017 through October 2019 for amoxicillin suspension, which has the greatest variation today, demand is 370% higher [in] October of this year,” says Mittal Sutaria, senior vice president of pharmacy contract and program services for Vizient. Production dropped during the unusually steep decline in flu cases during the COVID-19 pandemic, which Sutaria says may factor in to the lower availability today.
“The good thing is that the shortage is in amoxicillin suspension, which is easier to manufacture compared to other formulations,” Sutaria says. “So, we do anticipate that this challenge will be resolved within the season.”
Prioritize sound drug shortage stewardship
Sutaria emphasizes that drug shortages are nothing new. “You see increased demand seasonally between Q4 and Q1, during our winter months,” she says. However, hospitals are more concerned about today’s shortages partially because of the uncertainty behind the ongoing supply chain disruptions. “The healthcare providers and the purchasers don’t know if they’re going to get the next shipment or not. So, they’re also proactively ordering more, creating additional demand.”
Rather than stocking up on inventory, health systems should instead fall back on their principles of drug shortage stewardship, advises Sutaria. “We define that as managing demand through inventory management as well as mitigation strategies that can hopefully lessen the severity of the shortage by lessening the overall national demand,” she says.
Though health systems may be tempted to focus on stockpiling supply by leveraging their regional networks, a coordinated reduction of demand may prove most helpful in weathering the amoxicillin shortage. This could include strategies such as dispensing tablets or capsules to older pediatric patients where possible, or moving to next-step therapies for pediatric patients who would typically require treatment through amoxicillin suspension.
Better transparency can help alleviate demand
The shortage is also an excellent reminder for health systems to ensure they have, or are putting, practices in place to increase their supply chain transparency and visibility.
“Transparency is important because part of this demand increase is not having a true understanding of the true demand in the market,” Sutaria says. “If providers knew that there was sufficient supply to address the amounts that they needed for their critical patients, we wouldn’t see such an increase. And if suppliers knew what the true demand was, they would know how to plan their productions. Transparency is important both ways.”
Vizient is encouraging all stakeholders involved in the pharmaceutical industry, from manufacturers and distributors through providers, to put systems in place that enhance this visibility to better manage future demand. The company’s efforts on this front include the formation of the End Drug Shortages Alliance, an independent organization of supply chain stakeholders committed to addressing disruptions in medication availability, in early 2022.
“We consistently advocate for having increased transparency into the supply chain,” Sutaria says. “That is really the key for addressing these shortages.”