Pneumonia in the Time of an Antibiotic Shortage

December 6, 2022 9:37 PM

My 4 year old couldn't breathe. And the medicine was gone.
posted by foxfirefey (35 comments total)

I'm a medieval historian by training and antibiotic shortages as described in this essay terrify me to my marrow even when it's not my person. We have fucked around a lot with antibiotics. Shortages (and antibiotic resistance) are a really bad part of finding out.
posted by gentlyepigrams at 10:27 PM on December 6, 2022 [30 favorites]

God, WHY did I let myself read this? I'm anxious enough with three kids in school this winter as it is.
posted by potrzebie at 10:47 PM on December 6, 2022 [4 favorites]

This is so well written if heart breaking.
posted by freethefeet at 12:05 AM on December 7, 2022 [2 favorites]

Antibiotic growth promotion aka feeding anti-biotics to cows, pigs, etc. gives us more and cheaper meat, while decreasing anti-biotics effectiveness, and thus ultimately making searches like this lady did either risky or ineffective. It's fairly easy for doctors to prescribe an anti-biotic that simply does not cure your pneumonia.
posted by jeffburdges at 2:11 AM on December 7, 2022 [5 favorites]

But thank goodness no one is being forced to wear a mask or reconsider any of their risky behaviors in the midst of a pandemic now enhanced by a bad flu year and a bad RSV year. That would be a real tragedy. If someone lost their freedoms. While kids die from an antibiotic shortage.
posted by hydropsyche at 4:24 AM on December 7, 2022 [41 favorites]

Holy fuck, that was harrowing.
posted by rikschell at 4:46 AM on December 7, 2022

God, if you're a parent with a kid who gets sick all the time (we used to be a strep throat house), you really know that amoxicillin suspension. The sorta pleasant toy-pink, the heaviness when you shake up the bottle. Its ease and availability and cheapness. It tastes okay! You pick it up along with popsicles and saltines, and then go home to put your kid in front of very quiet cartoons for a day or so. They ought to sell it by the gallon. A shortage is just...like...okay, yes, call it first-world privilege to be shaken by the shortage of such a basic medicine, but it's like running out of aspirin or something, it's hard to picture it happening. We've lucked out the past few years, the kids have grown out of their frequent infections, and we've been rabid about masks, so even the usual colds have bypassed us. I literally did not know there was an antibiotic shortage right now, but you can bet I'm adding it to my list of things to panic over.

I was reading some discussion somewhere over whether the RSV surge was caused by an "immunity debt"--people had spent too long being protected from bacteria, and now that they were returning to normal life, their bodies weren't ready for the onslaught. It was one of those ideas that sounds okay until you think about it for thirty seconds (thirty seconds during which your system is absolutely being bombarded with bacteria from your surroundings, unless you read Metafilter in a sterile environment), and then you realize it's just another way to make people feel guilty for taking precautions, and anyway let's be serious, down here nobody took precautions in the first place, mask usage was never greater than 50%, attempts at social distancing were never followed after the first few months of the pandemic, so this presumed debt we'd been building up, was an illusion. I keep telling myself that because I'm really terrified that the kids will get sick now. They're not babies anymore, but what if? And no medicine? You can practically hear the little fear-rodent scream in my skull, that anxious screeee!

(Also, when did Meg start using Midjourney? Those pictures were beautiful!)
posted by mittens at 4:52 AM on December 7, 2022 [20 favorites]

Ugh, that stuff is how we discovered my amoxicillin intolerance. It is less pleasant on the way back up.
posted by aspersioncast at 5:41 AM on December 7, 2022 [1 favorite]

God, if you're a parent with a kid who gets sick all the time (we used to be a strep throat house), you really know that amoxicillin suspension.

Lord, yes. Back when we had kids (well, technically, we still have kids. They’re just grown-up and having their own kids now) amoxicillin was practically on the food pyramid in our house. It seemed like we were down at the pharmacy every couple of weeks getting yet another bottle for one of the kids.

We were such regular consumers that the pharmacist gave us a nifty promotional amoxicillin fridge magnet the pharma rep gave them. The pharmacist figured we had earned it.

It was a cool magnet, too. Just a large die-cut image of the bottle the stuff came in. The other parents who saw it on our fridge were quite envious.

Our granddaughter has an allergic reaction to all the *cillans, unfortunately. Nothing dangerous or uncomfortable, thankfully. She just breaks out in small red spots on her back. It doesn’t itch or anything, and the spots disappear with no scarring. Still, it’s better to be safe than sorry, so she doesn’t go near any of them when she needs an antibiotic, which can be kinda expensive in comparison to what the *cillans cost.
posted by Thorzdad at 6:05 AM on December 7, 2022 [8 favorites]

"but it's like running out of aspirin or something, it's hard to picture it happening"

There was a shortage of ordinary painkillers for children in Canada this fall.
posted by senor biggles at 6:07 AM on December 7, 2022 [16 favorites]

I have many thoughts about this and how lucky my kid had been so far despite being born by emergency caesarean at the beginning of the pandemic. though right now across the other side of Australia in Melbourne there are 12 hour waits in the emergency department of the children's hospital in summer and for a while there we couldn't get children’s acetimophen syrup but rail transport across the country is delayed again because of flooding related damage and this is just the beginning of the climate crisis and I presume this is how Romans felt? What stories did they tell? What form do they take in cultures today?

TLDR

This is the Home Culture piece that finally tipped me over into paying for my subscription.
posted by pipstar at 6:08 AM on December 7, 2022 [8 favorites]

At the end of the day, this is what happens when the entirety of human society is run for profit instead of human need.
posted by rhymedirective at 6:33 AM on December 7, 2022 [26 favorites]

There was a shortage of ordinary painkillers for children in Canada this fall.

Oh yeah, for some reason we ran out of pediatric acetaminophen in Canada. we were personally lucky we started the year with a full 3 pack, and I could always find a bottle when needed (go to the counter at the back of the pharmacy that's where the pharmacist is keeping them), we even gave one to the neighbors who have kids. They say a single bottle should last a long time.. but that's until you get 9 straight days of high fever, that chomps down on your stash of acetaminophen really fast. And we did end up in the ER because the doc suspected Kawasaki disease and that's not a diagnosis they can make outside of an hospital (good news, wasn't that, bad news they were out of space in the observation unit to start the immunoglobulin treatment if it had been that).

I still don't understand why we couldn't just thrown a bunch of adult tylenol with juice in a vitamix, blend it to max speed and then serve the proper quantity according to the child's weight. Probably works, I guess public health authorities are worried about the average math skill + potential for error.

I've heard that part of this was due to the fact younger kids couldn't get the antibodies they usually get from breastfeeding from their mother since the virus wasn't circulating amongst adults.
posted by WaterAndPixels at 6:40 AM on December 7, 2022 [3 favorites]

I both emptied my stores for neighbours/friends and smuggled bottles of infant painkillers/fever relief drugs over the border this fall and do not regret it. I have a 17-year-old sick who did a strep swab yesterday; hopefully everything goes okay from there.

I was trying to get over my hoarding tendencies and this does not help. It's why I had a bunch of bottles of things in my cupboard despite not having super young kids. I think with climate change coming, we will have to rethink some of our ways of doing things, including personal stores and also sharing...I was really glad to be a part of the local network of people who were working together to get kids the meds they needed (our school Facebook page kind of led the charge here.)

I feel so hard for parents of young kids right now; even being a parent of elementary and high school kids is exhausting beyond pre-pandemic standards and it has been for almost 3 years now.

Probably works, I guess public health authorities are worried about the average math skill + potential for error.

A compounding pharmacy can probably do this for people, but from my small use of Unusual Compounded Things And Kids, the shake before use becomes super important with something as toxic to the liver as Tylenol, so that may be why? Not sure.
posted by warriorqueen at 6:47 AM on December 7, 2022 [4 favorites]

My kids are old enough to take adult painkillers, but I still looked and asked every time I went into a pharmacy this fall for children's acetaminophen or ibuprofen for my friends who have young kids and couldn't find any.

Not even once did I find any.

I still don't understand why we couldn't just thrown a bunch of adult tylenol with juice in a vitamix, blend it to max speed and then serve the proper quantity according to the child's weight.

Compounding pharmacists basically do this type of thing. However, around here the compounding pharmacists were getting so many requests to make children's painkillers they had to do a news bit on it warning they couldn't fill all the requests.
posted by fimbulvetr at 6:57 AM on December 7, 2022 [1 favorite]

I was reading some discussion somewhere over whether the RSV surge was caused by an "immunity debt"--people had spent too long being protected from bacteria, and now that they were returning to normal life, their bodies weren't ready for the onslaught.

I believe the argument, at least as made by knowledgeable people, refers to very small children and RSV (a virus). I don't know (I don't know if we can know, at least not yet) whether it's true or not, but it's not as absurd as you've framed it to be; babies are usually exposed to RSV very early on, but a lot of babies-into-toddlers were kept out of the public sphere for the first two or three years of their lives.
posted by praemunire at 7:16 AM on December 7, 2022 [3 favorites]

I am not 20 minutes back from driving to two drugstores for kid's acetaminophen. Had to ask them to look in the back and they came out with a bottle. Looking pretty 2020 on the shelves in that section.
posted by Catblack at 7:17 AM on December 7, 2022 [9 favorites]

Yep. It's not just Canada though I guess? Kid Objects has gotten a bunch of colds so far this late summer/fall (and she's 4!! Reading the article made me want to weep).

However, I overbought Children's Tylenol and Motrin at Costco last year, but now we're running low. And the stores here in my part of Phoenix? Wiped out. Now I know why. I am also terrified. I'm glad to know I'm not alone in my feelings though.
posted by sharp pointy objects at 7:18 AM on December 7, 2022 [1 favorite]

It's just hell out here. I'm in Canada - 6 kids have died of the flu in BC in the last two weeks. They usually see 2 deaths/flu season - which runs until MARCH. Couldn't get anti-pyretics for the longest time. Pediatric wards across the country are turning people away. My kid's class had 4 students in attendance yesterday, out of 12. And it feels like nobody gives a shit.

And everyone is pushing the immunity debt thing and while I'm sure that plays SOME role like most kids my kid wasn't out of school for that long at all and has had...plenty of viruses over the last two years (loads and loads, it feels). And Sweden never locked down and their pediatric wards are full too, so...?

Anyway, I hate everything and our whole goddamn north american society doesn't. give. a. shit. about. children.
posted by stray at 7:23 AM on December 7, 2022 [23 favorites]

God, if you're a parent with a kid who gets sick all the time (we used to be a strep throat house), you really know that amoxicillin suspension.

In my family it was ear infections and erythromycin.

And we took adult Tylenol from my earliest memory, which would have been about age 4.
posted by The Underpants Monster at 8:59 AM on December 7, 2022 [1 favorite]

babies are usually exposed to RSV very early on, but a lot of babies-into-toddlers were kept out of the public sphere for the first two or three years of their lives.

As a parent if you're offered the choice to have your kid get RSV at three months old or at two years old, you take the second every time.

RSV severity is heavily tied to age. U.S. hospitalizations peak in the second month of life, and fall steadily month by month, down by ~10× at month 12.

And this is not a prior immunity effect, because RSV is seasonal in most places. All the younger kids here are having their first exposure. Or from another angle: birth month (in relation to the RSV season) strongly affects risk over the first year of life.

So I'd be interested in who's credibly making this case for RSV specifically. Because with what's previously known about RSV I'd expect any 'debt' of getting RSV later in life to be paid off at pennies on the dollar in terms of severe disease.
posted by away for regrooving at 9:09 AM on December 7, 2022 [14 favorites]

Where are we with the hygiene hypothesis? An interview with an immunologist on whether exposure to viruses helps the immune system to develop in children.

There's a virus called RSV, it's a respiratory virus. Almost all infants are positive for it by the age of two. But those who get severe disease are more likely to develop allergic disease and other problems. So this idea that we must become infected with a pathogenic virus to be healthy is not a good one.

posted by spamandkimchi at 9:57 AM on December 7, 2022 [17 favorites]

I still don't understand why we couldn't just thrown a bunch of adult tylenol with juice in a vitamix, blend it to max speed and then serve the proper quantity according to the child's weight.

You can't assume the drug is evenly distributed in the mixture. Tablets come with excipients (inert ingredients for binding). Some are designed for extended release, and for this reason should not be crushed. The ones that can be crushed would need to be reduced to a fine powder before mixing. Some drugs need to be mixed gradually using geometric dilution to avoid turning into a clumpy mess. Some drugs require a particular kind of diluent to remain in solution, otherwise they may precipitate. This is not necessarily straightforward stuff, which is why you need a pharmacy license to compound. Pediatrics + acetaminophen + home compounding + your average person's math/measuring skills just raises all sorts of red flags for me.
posted by dephlogisticated at 10:38 AM on December 7, 2022 [13 favorites]

I still don't understand why we couldn't just thrown a bunch of adult tylenol with juice in a vitamix, blend it to max speed and then serve the proper quantity according to the child's weight.

I wouldn't want to risk giving my small baby too much tylenol. its extremely toxic to the liver, even at not-too-much-bigger than the appropriate dose.
posted by supermedusa at 10:53 AM on December 7, 2022 [2 favorites]

You can't assume the drug is evenly distributed in the mixture. Tablets come with excipients (inert ingredients for binding). Some are designed for extended release, and for this reason should not be crushed. The ones that can be crushed would need to be reduced to a fine powder before mixing. Some drugs need to be mixed gradually using geometric dilution to avoid turning into a clumpy mess. Some drugs require a particular kind of diluent to remain in solution, otherwise they may precipitate. This is not necessarily straightforward stuff, which is why you need a pharmacy license to compound. Pediatrics + acetaminophen + home compounding + your average person's math/measuring skills just raises all sorts of red flags for me.

Thank you so much for this answer!

And just to reassure everybody, I didn't do this, but I was wondering why that wasn't an option. Now I know why, and it's a very interesting answer.

Because we weren't out of acetaminophen, we were out of the pediatric preparation, and it was bugging me why we couldn't provide something for kids. I also wished somebody on the news gave a condensed version of that explanation, because I can't the only person who was wondering, why it wasn't just a dilution of the normal stuff.
posted by WaterAndPixels at 10:58 AM on December 7, 2022 [3 favorites]

And we took adult Tylenol from my earliest memory,

We got the orange flavoured children's aspirin
Not made anymore. for good reason
posted by yyz at 11:28 AM on December 7, 2022 [2 favorites]

Walmart still has the 81 mg Bayers low-dose chewable tablets in orange and cherry flavors.

I tend to switch between those and generic ibuprofen and acetaminophen rather than use one pain relief continuously when sick (not all at one time, and not with multiple ingredient products).
posted by TrishaU at 1:59 PM on December 7, 2022

"but it's like running out of aspirin or something, it's hard to picture it happening"

There was a shortage of ordinary painkillers for children in Canada this fall.

My wife bought a whole bunch here in Chicago to take with her so my M-I-L could distribute it through her rural friend network. The crazy part is that none of us are under 50. It's just rural mutual support networks holding things together at this point.

Unfortunately I caught covid and the trip to Canada was cancelled. When it rains it pours.
posted by srboisvert at 4:11 PM on December 7, 2022 [2 favorites]

Reminder that children should not take aspirin because of the risk of developing Reye's Syndrome, which occurs usually with aspirin use after a viral infection (i.e., exactly the situation many kids are currently in). This is why children's acetaminophen and ibuprofen are so important.
posted by hydropsyche at 7:25 PM on December 7, 2022 [4 favorites]

dephlogisticated: "Pediatrics + acetaminophen + home compounding + your average person's math/measuring skills just raises all sorts of red flags for me."

Never mind pediatrics. I went to a pharmacy to get something compounded a couple of years ago, & I overheard the pharmacy tech & a manager trying to figure out a 10% dilution. On the bright side, for a while there I had all the testosterone.
posted by sneebler at 7:43 PM on December 7, 2022

As a parent if you're offered the choice to have your kid get RSV at three months old or at two years old, you take the second every time.

Unless every young kid in the county is getting it at roughly the same time, dramatically straining health-care resources.

I'm sure there are morons out there saying moronic things on this topic, but everyone I've heard talking about "immunity debt" is referring to the reason for the current RSV spike. Everyone's getting it at the same time because everyone's being exposed to it for the first time at the same time.
posted by praemunire at 11:19 PM on December 7, 2022 [3 favorites]

A good read to be sure, but my 14 yo is home with a fever today, so the timing could have been better.

She's managed to wrangle MidJourney to produce some lovely illustrations, I must say.
posted by Harald74 at 12:21 AM on December 8, 2022

Everyone's getting it at the same time because everyone's being exposed to it for the first time at the same time.

Sure. From which you would expect a normal year of RSV hospitalization plus the hospitalizations resulting from first-exposure two- and three-year-olds. Which, given the known age/risk relation, would be a small fraction of the yearly infant hospitalization numbers. I don't see it working quantitatively as an explanation.

If someone has engaged with the details and made the math work, please reference!
posted by away for regrooving at 9:04 PM on December 8, 2022 [1 favorite]

Related UK worries: @LibDemPatrick @xr_cambridge
posted by jeffburdges at 4:01 PM on December 9, 2022

I'm sure there are morons out there saying moronic things on this topic, but everyone I've heard talking about "immunity debt" is referring to the reason for the current RSV spike. Everyone's getting it at the same time because everyone's being exposed to it for the first time at the same time.

Except this is not borne out by the data. First, even the simplistic math is off. The current spike is higher than what would be predicted from piling multiple years of infection into one. Second, there was no shortage of RSV last year (there was in 2020). Third, regional comparisons based on when children were held out of school (ie - not all in sweden, barely at all for many US private schools, state by state and city variation) show that the RSV is steadily accumulating rather than merely catching up post child isolation (which is no longer accumulating). It's not experimental evidence but it is as close as you can possibly get and the evidence for covid-19 causing some sort of immune dysregulation in children is looking pretty strong while the immunity debt logic requires ignoring lots of countervailing indicators and awkward timing sequences that undermine debt causality. I shudder to imagine what we might be looking at if there is something like measles immune dysregulation which can cause subacute sclerosing panencephalitis that delivers its consequential payload years later. It's bad enough that covid-19 increases all cause mortality in the short term for adults but just imagine if an entire generation of deliberately infected kids have slow developing encephalitis or some other illness. Not only will there be the horror of what happens to the kids but there will also be the self-inflicted damage to the national psyche of knowing this was a choice we collectively made as a society. I'm not sure how that kind of thing would even play out. I suspect it will lead to madness.
posted by srboisvert at 3:33 AM on December 10, 2022 [8 favorites]