Amoxicillin Suspension Shortage

Outpatient Antibiotic Recommendations During Oral Antibiotic Shortage

Child requires amoxicillin or amoxicillin/clavulanate suspension
Oral capsule or tablet is clinically appropriate based on dose per Table 1
Antibiotics and dose forms impacted by shortage Table 3
Yes
No
Preferred to prescribe oral capsule
or tablet
See Administration Instructions
Prescribe an alternative antibiotic per
Table 2 based on availability
Table 1. Weight-based Amoxicillin Tablet/Capsule Recommendations for AOM, CAP, and Sinusitis
Weight Dose and formulation
< 5 kg Capsules/tablet dosing not an option
See alternative options below
5-6.2 kg Amoxicillin 250 mg cap twice daily
6.2-7.4 kg Clindamycin 75 mg cap three times daily (***CAP only)
7.5-9 kg Capsules/tablet dosing not an option
See alternative options below
9-11 kg Amoxicillin 437.5 mg (one-half x 875 mg tab) twice daily
> 11-12.9 kg Amoxicillin 500 mg cap twice daily
13-14.9 kg Amoxicillin 656.25 mg (three-quarters x 875 mg tab) twice daily
15-18 kg Amoxicillin 750 mg (3 x 250 mg cap) twice daily
> 18-20 kg Amoxicillin 875 mg tab twice daily
20-25 kg Amoxicillin 1,000 mg cap twice daily
> 25-30 kg Amoxicillin 1,312.5 mg (1.5 x 875 mg tab) twice daily
> 30-35 kg Amoxicillin 1,500 mg (3 x 500 mg cap/tab) twice daily
> 35-40 kg Amoxicillin 1,750 mg (2 x 875 mg tab) twice daily
> 40 kg Amoxicillin 2,000 mg (4 x 500 mg cap) twice daily
Administration Instructions for Capsules and Tablets
Capsules PO Open capsule and disperse contents into juice, apple sauce, or pudding and immediately consume.
Should only be used for doses that can be rounded to increments of whole capsules.
Feeding Tube Open capsule and disperse contents into 15-30 mL of water and immediately administer per tube. Flush with 10 mL of water.
Tablets PO Crush tablet to fine powder and disperse contents into juice, apple sauce, or pudding and immediately consume.
Feeding Tube Crush tablet to fine powder and disperse contents into 15-30 mL of water and immediately administer per tube. Flush with 10 mL of water.

Note: Chewable tablets can be split and chewed by mouth. Do not crush.

Table 2. Preferred and Alternative Antibiotic Recommendations
Condition Alternative Recommendation
Otitis Media
  • Consider watchful waiting in children ≥ 2 years without severe disease – many will experience spontaneous resolution
  • Preferred: Amoxicillin tab or capsule
  • Alternatives (listed in order of preference):
    1. Amoxicillin-clavulanate
    2. Ceftriaxone IM single dose
    3. Cefpodoxime (improved oral absorption compared to cefdinir)
    4. Cefdinir
    5. Clindamycin
    6. Azithromycin
  • For severe cephalosporin or penicillin allergy1: Clindamycin, oral
Community Acquired Pneumonia
  • Preferred: Amoxicillin tab or capsule
  • Alternatives (listed in order of preference):
    1. Amoxicillin-clavulanate
    2. Clindamycin
    3. Cefpodoxime (improved oral absorption compared to cefdinir)
    4. Cefdinir
  • For severe cephalosporin or penicillin allergy1: Clindamycin, oral
Acute Bacterial Sinusitis
  • Preferred: Amoxicillin tab or capsule
  • Alternatives (listed in order of preference):
    1. Amoxicillin-clavulanate
    2. Clindamycin and Cefpodoxime or Cefdinir
  • For severe cephalosporin or penicillin allergy1: Levofloxacin, oral
Group A Streptococcus Pharyngitis
  • Preferred:
    • Amoxicillin tab or capsule, oral
    • or
    • Penicillin V potassium, oral
    • or
    • Penicillin G benzathine, IM
  • Alternative: Cephalexin
  • For severe cephalosporin or penicillin allergy1: Clindamycin, oral
Dental Abscess or Tooth Avulsion, Localized Swelling
  • Preferred: Amoxicillin tab or capsule
  • Alternatives (listed in order of preference):
    1. Penicillin V potassium, oral
    2. Amoxicillin-clavulanate
    3. Clindamycin, oral
UTI Prophylaxis
  • Preferred: Amoxicillin for infants ≤ 4 weeks
  • If not available, contact ID Abx Approval for guidance
  1. Penicillin allergy: Assess the nature of the penicillin allergy per the Clinical Pathway for the Assessment of Children with a Penicillin Drug Allergy. Severe penicillin allergy includes any of the following: anaphylaxis, angioedema, cardiac arrest, respiratory distress, severe cutaneous reaction (for example, Stevens-Johnson syndrome, erythema multiforme, DRESS and TEN). All other reactions are considered non-severe.

Table 3. Antibiotic Formulations

Note

  • Italic red text indicates that drug supply availability may be limited or not available
  • Capsules and tablets can be opened or crushed unless specified below
Drug Options and Formulations Capsule/Tablet Chewable Suspension/Solution
Amoxicillin
  • Capsule:
    • 250 mg
    • 500 mg
  • Tablet:
    • 500 mg
    • 875 mg
  • 125 mg
  • 250 mg
  • 125 mg/5 mL
  • 200 mg/5 mL
  • 250 mg/5 mL
  • 400 mg/5 mL
Amoxicillin-clavulanate
  • Tablet:
    • 250-125 mg
    • 500-125 mg
    • 875-125 mg
  • Extended release:
    • 1,000-62.5 mg Cannot be crushed
  • 200-28.5 mg
  • 400-57 mg
  • 200-28.5 mg/5 mL
  • 250-62.5 mg/5 mL
  • 400-57 mg/5 mL
  • Extra-strength:
    600-42.9 mg/5 mL
Cefdinir
  • Capsule:
    • 300 mg
  • 125 mg/5 mL
  • 250 mg/5 mL
Cefpodoxime
  • Tablet:
    • 100 mg
    • 200 mg
100 mg/5 mL
Ceftriaxone, IM Injection: 1 gram and 2 gram
Cephalexin
  • Capsule:
    • 250 mg
    • 500 mg
    • 750 mg
  • Tablet:
    • 250 mg
    • 500 mg
  • 125 mg/5 mL
  • 250 mg/5 mL
Clindamycin
  • Capsule:
    • 75 mg
    • 150 mg
    • 300 mg
75 mg/5 mL
Levofloxacin, oral
  • Tablet:
    • 250 mg
    • 500 mg
    • 750 mg
25 mg/1 mL
Nitrofurantoin
  • Capsule:
    • 25 mg
    • 50 mg
    • 100 mg
25 mg/5 mL
Penicillin VK, oral
  • Tablet:
    • 250 mg
    • 500 mg
  • 125 mg/5 mL
  • 250 mg/5 mL
Penicillin G, Benzathine, IM Injection: 600,000 units/1 mL and 1,200,000 units/2 mL
Trimethoprim-sulfamethoxazole (TMP-SMX)
  • Tablet:
    • 80-400 mg
    • 160-800 mg
40-200 mg/5 mL

See CHOP Formulary for complete information.

References