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 for AOM, CAP, and sinusitis
Table 2 for strep pharyngitis, dental abscess, and UTI prophylaxis

Antibiotics and dose forms impacted by shortage Table 4

Patient and Family FAQs

Yes

Preferred to prescribe oral capsule
or tablet
See Administration Instructions

Prescribe an alternative antibiotic per
Table 3 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

Table 2. Weight-based Amoxicillin Tablet/Capsule Recommendations for Group A Streptococcus Pharyngitis, Dental Abscess or Tooth Avulsion, Localized Swelling, and UTI Prophylaxis
Weight	Dose and formulation
< 4 kg	Capsules/tablet dosing not an option See alternative options below
4-4.4 kg	Amoxicillin 218.75 mg (one-quarter x 875 mg tablet) once daily
≥ 4.5-5.5 kg	Amoxicillin 250 mg cap once daily
5.6-7.8 kg	Capsules/tablet dosing not an option See alternative options below
7.9-9.5 kg	Amoxicillin 437.5 mg (one-half x 875 mg tab) once daily
9.6-11 kg	Amoxicillin 500 mg cap once daily or amoxicillin 250 mg cap twice daily
11.1-11.7 kg	Capsules/tablet dosing not an option See alternative options below
11.8-13.4 kg	Amoxicillin 656.25 mg (three-quarters x 875 mg tab) once daily
13.5-16.5 kg	Amoxicillin 750 mg (3 x 250 mg cap) once daily
16.6-17.9 kg	Amoxicillin 875 mg tab once daily
≥ 18 kg	Amoxicillin 1,000 mg cap once daily or amoxicillin 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.
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.
Tablets	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 3. 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): Amoxicillin-clavulanate Ceftriaxone IM single dose Cefpodoxime (improved oral absorption compared to cefdinir) Cefdinir Clindamycin Azithromycin For severe cephalosporin or penicillin allergy¹: Clindamycin, oral
Community Acquired Pneumonia	Preferred: Amoxicillin tab or capsule Alternatives (listed in order of preference): Amoxicillin-clavulanate Clindamycin Cefpodoxime (improved oral absorption compared to cefdinir) Cefdinir For severe cephalosporin or penicillin allergy¹: Clindamycin, oral
Acute Bacterial Sinusitis	Preferred: Amoxicillin tab or capsule Alternatives (listed in order of preference): Amoxicillin-clavulanate 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): Penicillin V potassium, oral Amoxicillin-clavulanate Clindamycin, oral
UTI Prophylaxis	Preferred: Amoxicillin for infants ≤ 4 weeks If not available, contact ID Abx Approval for guidance

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 4. 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

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