April 13, 2023

What You Should Know About Strep Throat and the Amoxicillin Shortage

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You or your kids may already been familiar with strep throat; I know I had to suffer through lots of throat swabs and pink liquid medicine as a kid. But the medication to treat it is in short supply right now, and the CDC has recently warned that they’re seeing an uptick in cases of the more severe forms of group A strep. Here’s what that all means.

What is strep?

“Strep” is a nickname for two different types of bacteria. Streptococcus pyogenes is known as group A strep, and it’s the kind that causes strep throat. (“Strep” refers to a chain shape, and “coccus” to a ball shape, because these bacteria appear under the microscope as a chain of little balls.)

Group A strep is responsible for:

  • Strep throat
  • Scarlet fever (also called scarlatina)
  • Impetigo, a skin infection
  • Rheumatic fever
  • Some types of toxic shock syndrome, cellulitis, and necrotizing fasciitis

By contrast, group B strep is a different species, best known for causing serious infections in newborns who pick up the bacteria during birth.

What are the symptoms of strep throat?

Strep throat’s typical symptoms are sore throat and fever. Scarlet fever is similar, but also includes a rash. And even though “scarlet fever” sounds like something out of a Dickens novel, it’s still fairly common these days in children between the ages of 5 and 15. Fortunately, it’s treatable.

The signs of strep throat include a red throat, white patches on swollen tonsils, and little red spots called petechiae on the roof of the mouth. The CDC has a graphic and some more information here. Strep throat normally does not include a cough or runny nose.

Scarlet fever also tends to involve a red, sore throat, and the child may have a whitish coating on the tongue that progresses to a bumpy “strawberry” appearance. There is often a red, sandpaper-textured rash that appears in folds of skin, such as their armpits.

Impetigo is a skin condition that can be caused by group A strep or by another type of bacteria (Staphylococcus aureus). Its telltale sign is red, itchy sores with yellow scabs, either around the mouth or on the arms and legs.

Strep throat and scarlet fever can both be transmitted by respiratory droplets (like from coughs or sneezes, or being in very close contact with a person who is sick). Impetigo can spread from touching the sores.

Invasive strep infections are on the rise

The infections mentioned above are usually not serious as long as they’re treated promptly. If you think your child has one of these infections, seek care and get antibiotics. (Adults can also get these infections, so definitely get yourself checked out too, if needed.)

Untreated, they can progress to more serious diseases. The CDC recently warned doctors and parents about “invasive group A strep” diseases, in which the germs get into body parts that normally don’t come into contact with bacteria at all. These can be very severe—even life threatening. These invasive diseases include necrotizing fasciitis (sometimes known as “flesh eating bacteria”) and the streptococcal version of toxic shock syndrome.

The CDC says to make sure to treat mild cases of strep promptly, and to lower your risk of the invasive diseases by staying up to date on flu and chickenpox vaccines. Flu and chickenpox make you more susceptible to invasive infections.

How is strep treated?

Unlike colds and flu, strep is one of the common illnesses that can be successfully treated with antibiotics. For young children, one of the more common medications is a liquid preparation of amoxicillin. (It’s the stuff that looks almost like a strawberry milkshake.)

There’s currently a shortage of the powder that pharmacies use to mix up this liquid medication. If you get it prescribed, and the pharmacy doesn’t have it, ask your pediatrician for alternatives. There is not a shortage of amoxicillin in general, just of this common preparation of it.

The American Association of Pediatrics has a page for physicians on what medications they can order instead of the usual liquid. Capsules, tablets, and chew tabs are available. Children who cannot take these may be able to take them if they are crushed and mixed into a liquid or food like applesauce. If amoxicillin isn’t available, other antibiotics may be appropriate.

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