Over the past winter, cases of Streptococcus (strep) bacterial infections have surged. Now, an ongoing antibiotic shortage is further exacerbating cases as patients struggle to get effective treatments.

Cases of strep surge throughout the US

Between January 2017 and February 2020, strep throat infections followed a seasonal pattern of rising in September and peaking in February. However, this changed after the pandemic hit in March 2020. During the pandemic, cases of strep, along with many other respiratory illnesses, decreased significantly as COVID-19 surged.

According to a new analysis from  Epic Research, strep throat infections surged this past winter, reaching their highest rate since February 2017. Compared to this pre-pandemic peak, cases of strep in February 2023 were almost 30% higher.

According to the researchers, cases of strep were most common among children ages 4 to 13, but individuals from all age groups have seen a similar rise in cases. Currently, CDC is tracking a particularly aggressive form of strep called invasive group A strep. Instead of staying localized in the throat, this form of strep spreads to other parts of the body. Although cases of invasive strep hit record lows in 2020 and 2021, they are now higher than usual this season.

A shortage of antibiotics is making the problem worse

Amoxicillin products, which are used to treat strep, have been in short supply since October. Currently, there are several shortages of pediatric versions of the antibiotic, including multiple generic brands, such as Sandoz and Teva.

According to NPR, the ongoing shortage is likely caused by a significant increase in demand rather than any quality issues.

"Companies typically look to see what their sales were the prior year. They might make a little bit of an adjustment," said Erin Fox, a national expert on drug shortages at the  University of Utah. "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."

Because there do not seem to be any manufacturing or quality issues, Fox said she hopes drugmakers will be able to predict supply more accurately for next year. For now, pharmacists will likely have to use other options amid the ongoing shortage.

"You might need to switch," Fox said. "So you might have to take a little bit more volume... I have given children antibiotics, and I know that that's not fun, but you can do that."

Fox added that parents may need to call different pharmacies if their local pharmacy does not have any amoxicillin on hand. Because amoxicillin is not a controlled substance, pharmacists can share information on other pharmacies' stocks to assist those in need.

"We had to visit several pharmacies to find the medication that we needed," said Caitlin Rivers, an epidemiologist at the  Johns Hopkins Center for Health Security whose two children recently had strep. "It just adds another burden on what's already been a really difficult winter respiratory season for families."

Although strep cases usually peak by the end of April, Rivers said she can't be sure that will be the case this year, particularly with the ongoing shortage of amoxicillin and the pandemic having upended the usual winter illness trends. "[I] can't be confident that April will mark the end of this strep throat season," she said. (Prieb, The Hill, 4/19; Lupkin, "Shots," NPR, 4/10)