According to the Therapeutic Goods Administration (TGA), the shortage is expected to last until late November.

So what’s causing these shortages, and what are the alternatives if you can’t get this medicine for your child?

First, what is azithromycin for?

Azithromycin, sold under brand names including Zithromax, Zithro or just Azithromycin, is one of our most patient-friendly antibiotics. It requires a dose just once daily, and the courses are short (usually five days or fewer). It works against a wide range of bacteria, and it’s formulated as a liquid and a tablet.

In childhood, azithromycin is used to treat respiratory illnesses such as pertussis (whooping cough) and Mycoplasma pneumonia.

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. So, it’s not a good time for azithromycin liquid to be in short supply.

Azithromycin is also very useful for children living in remote Indigenous communities. It may be used to treat wet cough or Strep A sore throats (caused by group A streptococcus bacteria). If these infections are not managed, they can lead to permanent lung damage or rheumatic fever.

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

Recent reports suggest hundreds of medicines are in short supply in Australia. These shortages reflect complex global supply chains.

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.

Of course, the shortages affect many medicines adults take, too. But the issue disproportionately affects children because they rely on on syrups and liquids, which are produced less commonly than tablets. 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?

The alternatives to azithromycin have challenges. 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.

For Strep A sore throats, the alternative to azithromycin is either a longer course of oral antibiotics (20 doses versus five doses) or benzathine benzylpenicillin (Bicillin L-A), a medicine given by injection. But this latter option is painful and also in short supply.

The TGA 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 reasonable prices.

Are tablets an option?

Shopping around while your child is sick is likely to be difficult and frustrating.

If you can’t find a liquid formulation and you think your child can swallow a tablet, ask your doctor whether they can prescribe the tablet form.

Parents can help children learn this skill by teaching them to swallow tic-tacs, mints, or other small, similarly shaped sweets.

Another option is to try Panadol or Nurofen tablets when a child has a fever to see if they can start to swallow them so you are ready to transition.

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?

Healthy childhood growth means the medication dose needed for each child is always changing. Syrups and liquids make it easier to measure the correct amount required based on weight for individual children.

If the correct dose is either half or one-quarter of a tablet, azithromycin tablets can be split and crushed.

Splitting tablets is less accurate, though. Splitting and crushing tablets also increases the bitter flavour that the outer coating may mask.

Tricks to mask the bitterness include mixing the crushed tablet with a teaspoon of Nutella, jam or custard.

We need solutions

Antibiotic shortages can affect any child, including our most vulnerable children across Australia.

Part of the problem is the interconnected global supply chains with limited producers of vital antibiotics. Alternative suppliers need to be rapidly sought.

Additionally, Australia needs better systems for monitoring the risks of stock shortages and communicating these to reduce the impact. Communicating 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.

Asha Bowen, Team Lead, Healthy Skin and ARF Prevention, Telethon Kids Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.