Key Points
- Azithromycin is facing liquid formulation shortages.
- The Therapeutic Goods Administration expects the shortage to last until towards the end of the year.
- There are challenges with the pill versions and the alternatives.
So what’s causing these shortages, and what are the alternatives if you can’t get this medicine for your child?
There is currently a shortage of Azithromycin in its liquid form, causing challenges for parents of sick children who need the medicine. Source: Getty / NoDerog
First, what is azithromycin for?
Following a lull in several infectious diseases during the COVID pandemic, pertussis is now surging among Australian children. Cases of Mycoplasma pneumonia have also increased in recent months.
Further, Australia is the only high-income country where trachoma exists. This eye infection affects people living in remote Indigenous communities and can cause blindness over time. Azithromycin is the only effective antibiotic to prevent blindness from this infection.
Supply chain issues
Manufacturing issues or sudden increases in demand are common reasons for medicine shortages. The TGA has cited an “unexpected increase in consumer demand” as the reason for the azithromycin shortage, so the sudden return of pertussis in Australia and globally may be behind it.
Syrup or liquid formulations may have only a single approved supplier, whereas tablets are likely to have many.
So what if you can’t get the liquid formulation?
Clarithromycin requires twice-daily dosing, the liquid form tastes bitter and, in any case, this drug is also facing a shortage. Doxycycline only comes as a tablet and is not usually given to children under eight years.
It can be difficult enough for parents to get children to take medicine when it comes in liquid form. Source: Getty / Karl Tapales
The TGA has recently announced the temporary supply of a different brand of azithromycin liquid formulation registered overseas. Let’s hope this will ease supply problems over the coming months. It will also need leadership to ensure prices are reasonable.
Are tablets an option?
Parents can help children learn this skill by practising swallowing tic tacs, mints or other small, similarly shaped sweets.
Some children as young as three can do this, but it’s not generally recommended for children until age four, and most learn after six or older.
Can I split a tablet?
If the correct dose is either half or one-quarter of a tablet, azithromycin tablets can be split and crushed.
While it is possible to split a pill, when taking part of a pill, there is often an unsavoury taste that comes with it. Source: Getty / Bill Oxford
Splitting tablets is less accurate though. Splitting and crushing tablets also increases the bitter flavour that the outer coating of the tablet may mask.
Tricks to mask the bitterness include mixing the crushed tablet with a teaspoon of Nutella, jam or custard.
We need solutions
Communication of medicine shortages in a timely, efficient, and widespread way won’t solve the problem – but it will help clinicians, parents, and families navigate these challenges.