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Impact of Amoxicillin Shortage on Pediatric Antibiotic Prescriptions in Primary Care

Federica Pagano1,2, Giulio De Marco3, Benedetta Trojano1

  • 1Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.

Antibiotics (Basel, Switzerland)
|March 28, 2025
PubMed

Insights

The amoxicillin shortage in Italy led to increased prescriptions of second-line antibiotics, potentially reversing gains from antimicrobial stewardship programs. This shift highlights the vulnerability of antibiotic access and its impact on prescribing quality.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Pharmacology

Background:

  • A prior study in Southern Italy demonstrated the success of an antimicrobial stewardship program in primary care.
  • National amoxicillin shortages began in autumn 2022, coinciding with a rise in pediatric respiratory infections post-COVID-19 restrictions.

Purpose of the Study:

  • To evaluate the effect of amoxicillin shortage on antimicrobial prescribing habits and quality metrics in primary care.
  • To compare current prescribing patterns with those from a previous antimicrobial stewardship (AMS) campaign.

Main Methods:

  • Retrospective analysis of antibiotic prescriptions (amoxicillin, amoxicillin-clavulanate, cephalosporins, macrolides, quinolones) in a pediatric primary care setting.
  • Monitoring of antibiotic availability in local pharmacies to assess drug accessibility.
  • Calculation of amoxicillin/amoxicillin-clavulanate and Access/Watch indices as quality indicators.

Main Results:

  • A 5-7 month amoxicillin shortage affected 90% of pharmacies from November 2022 to May 2023.
  • Significant increases in amoxicillin-clavulanate and third-generation cephalosporin prescriptions were observed.
  • A notable decline in the amoxicillin/amoxicillin-clavulanate index indicated a shift away from first-line therapy.

Conclusions:

  • The amoxicillin shortage likely prompted increased use of second-line antibiotics in Italian primary care.
  • This trend may undermine previous efforts in antimicrobial stewardship and rational antibiotic use.
  • Ensuring consistent access to essential antibiotics like amoxicillin is crucial for maintaining effective antimicrobial stewardship.

Keywords:
amoxicillinantimicrobial stewardshipdrug accessibilityprimary careshortage

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