Emergency compounding provisions for the oral antibiotic medication amoxicillin are in place across the country as Australia's regulatory body for medicines declares the drug as "scarce".
The Therapeutic Goods Administration (TGA) said shortages due to overseas manufacturing issues has impacted supply of the antibiotic.
Amoxicillin is an antibiotic widely used to treat bacterial infections including Streptococcus A, middle ear infection, strep throat, pneumonia, skin infections, and urinary tract infections among others.
Newcastle compounding pharmacist Winston Lo says that in 25 years as a chemist he has never seen amoxicillin supplies so critically low.
"To give you an idea, we have never made this before and now we are getting five or 10 phone calls a day," he said.
To address the shortage, the TGA has put a Serious Scarcity Substitution Instrument (SSSI) in force.
The SSSI allows community pharmacists to substitute specific medicines without prior approval from the prescriber so long as the permitted circumstances within the substitution protocol are met.
It allows community pharmacists to compound the listed medication to ensure medical treatments are not disrupted, although the preference is for chemists to dispense an alternate amoxicillin syrup or suspension strength when the prescribed one is unavailable.
Rationing in place
Rationing for the antibiotic is in place in areas such as the New South Wales' Hunter region.
Newcastle and Hunter Valley Pharmacists Association president Luke Kelly says the constrained supply has been challenging.
"We've got a WhatsApp group, so if a pharmacy doesn't have medication they'll post the request and then a nearby pharmacy will say 'I've got it'," he said.
"We direct the patient to the pharmacy so they don't miss out."
The WhatsApp group works to link stockpiles of amoxicillin to those in need, particularly children.
Compounding at pharmacies such as Mr Lo's is also being ramped up, but the medicine cannot be made in advance and must be made to order.
This can be cost prohibitive.
A medicine that could be available on a subsidised script for as low as $7 may end up costing up to nine times as much.
"By the time we compile them, pay the wages, plus half an hour to make it up, it'll be $50 or $60," Mr Lo said.
Scarlet fever on the rise
The amoxicillin shortage coincides with a spike of cases in group A streptococcus (Strep A) in children.
Public health physician David Durrheim said the New South Wales Hunter New England Health District typically dealt with a handful of scarlet fever cases each year, but cases were on the rise.
The region has already recorded 22 cases since September.
Dr Durrheim said in the wake of the incursion, sore throats, rashes and lethargy in children could not be be ignored.
"Every now and then you get an invasive strain and that can be deadly," he said.
"It gets into the blood stream and can cause sepsis. It can cause meningitis and pneumonia as well and so it can't be ignored."
Dr Durrheim said he was hopeful amoxicillin supply issues could be resolved.
"I know the Australian government is making sure there are adequate supplies because it is really important that we have antibiotics that are readily available," he said.
The TGA has not declared the 250mg capsules of amoxicillin as scarce medicines because of the potential impact this would have on supply of the liquid formulations.
The SSSI is in force until May 31, 2023.
