Kids all over the US are getting strep, but antibiotics are hard to come by

A new report from the Centers for Disease Control and Prevention (CDC) reports that cases of infections from A Streptococcus (commonly called strep-a or strep throat) have surged this past winter. During the time period while most COVID-19 mitigations were still in place, cases dropped by about 25 percent, but now cases are above pre-pandemic levels. 

Across the US, the CDC report found that the most severe cases of invasive group A strep infections have been seen in children. Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, told NPR that in an invasive strep infection, the bacteria has spread to other parts of the body instead of just staying in the throat. It can spread to the bloodstream, cause rashes on the skin, and even infect the body’s organs. 

[Related: Strep throat is figuring out how to beat our go-to antibiotics.]

The recent spike in strep throat cases coincides with a shortage of amoxicillin, an antibiotic commonly used to treat strep throat, especially in children. Rivers also recounted the difficulty her own family and patients have had finding the antibiotics needed to treat strep cases. “We had to visit several pharmacies to find the medication that we needed,” she tells NPR. “It just adds another burden on what’s already been a really difficult winter respiratory season for families.”

Health officials in Illinois warned parents in March to be vigilant, as five pediatric deaths were reported in the state. Illinois Department of Public Health Director Sameer Vohra warned that cases of strep throat infections that lead to severe complications were on the rise in the state “with more cases reported in 2023 than in any of the past five years.”

In October 2022, the Food and Drug Administration (FDA) added amoxicillin products to its list of drug shortages.  Some amoxicillin medications are still not widely available. The shortage is linked to the lack of liquid versions of products  that are easier for children to consume The shortage is affecting multiple generic brands, including Teva and Sandoz.

The current shortage appears to be a demand issue and not a quality issue. “Companies typically look to see what their sales were the prior year. They might make a little bit of an adjustment,” Erin Fox, a national expert on drug shortages at the University of Utah, told NPR. “But with the really severe respiratory season we’ve had this year, it just simply was a mismatch between what people manufactured and what was available.”

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Fox also added that while a popular strength of amoxicillin – 400 mg/5mL – isn’t always available, pharmacists have other options, like giving a lower dose at a greater volume. Shortages of many commonly used prescription medications, including adderall and some diabetes drugs, have been common throughout the United States over the past year. Increases in demand and supply chain issues being partially to blame. 

Strep throat cases are typically most common from December through April, however the pandemic has thrown seasonal infection cycles off their usual track. RSV surged especially early and severely in late summer and fall 2022 along with norovirus.

Some of the most common strep throat symptoms include pain, fever, swollen tonsils, and tiny spots at the roof of the mouth called petechiae. Infected patients should see a healthcare provider if the symptoms become serious, get worse, or if they do not go away after two weeks of initial treatment.