A Dose of Reality About Fever-Reducing Medications and Antibiotics

BY

You may have heard about it from your pediatrician or pharmacist.  And it’s true.  There is a shortage of Infant’s and Children’s Tylenol and Motrin and children’s antibiotics to treat common sicknesses like ear infections and strep throats.  Medications  for ADD/ADHD are in short supply.

What’s happening?

Presently, we are in one of the most virulent sick seasons ever for children.  We are experiencing a “tripledemic” of respiratory syncytial virus (RSV), flu, and Covid.  Additionally, there is invasive strep throat.  There are so many more viruses than I can enumerate here that must be monitored in our precious children that are beyond antibiotics.  And, unfortunately, with the shortages of Motrin and Tylenol (CVS and Walgreens have placed nationwide limits on pain-reducing medication), it is all but impossible to find fever-reducing medications to make our children comfortable as these viruses gallop through their bodies making them beyond miserable (but pathetically endearing).  It’s challenging for physicians and parents alike.

Let’s first discuss these viruses.

RSV is not a new virus but we are hearing more about it this season for several reasons.  Thankfully, we have resumed many typical pre-Covid activities without masks and social distancing practices.  Masking and social distancing were (almost) perfect methods for reducing incidences of RSV and other seasonal respiratory viruses.  Some have theorized that community immunity has waned since RSV hasn’t been predictable regarding seasonality or severity since March 2020, the onset of the Covid-19 pandemic.

Atypically, we experienced RSV spikes the last two summers.  But this fall and now the winter – Well, it’s pushed pediatric offices and hospitals to the edge.  All ages are susceptible to RSV (think of the “common cold” in older children and adults) but RSV must be closely monitored in infants and young children as it can become severe on the turn of a dime, leading to respiratory distress, hospitalizations, and G-d forbid, even death.   RSV produces copious amounts of mucus in the respiratory tract which makes it harder to breathe.  It’s no wonder how an infant less than 6 months of age and/or with co-occurring respiratory or cardiac conditions may have difficulties with this virus.  It can lead to ear infections or pneumonia which could mean hospital or intensive care admission.  It is common that infants who weather the virus (or any combination thereof) may fare well but still experience a lingering cough which causes concern.  Consistent, professional care that has been trained in diagnosing ears and breathing issues, combined with parental love and support, is key.

The flu is our next focus.  It is a worthy contender to RSV.

Every year, the flu puts thousands of children into the hospital.  Already this season, it has been reported that this flu season is the worst since the 2009 H1N1 swine flu pandemic.  This is not a surprise.  Most experts predicted a nasty flu season because of the low immunity throughout the population due to the masking and social distancing of the previous two years.  Many of the population in the Southern hemisphere were decimated in their winter months.

The flu can cause cough, fever, fatigue, muscle aches, headaches, congestion and more in children, including severe illness and even, G-d forbid, death.  In fact, the first infant death due to the flu in the United States for this season occurred by mid-November.  It’s real.  And that’s why I’m an unabashed proponent of the flu vaccine.  While the vaccine may not prevent the flu from happening, it will help to mitigate its “bite” and harm.  No child should die from a preventable death and the flu vaccine will help to reduce flu illness and hospitalizations and to thwart deaths.

And it’s not too late to make sure that your children have their flu shots done.

Then there’s Covid.

So much has been written about this the last nearly three years and so much remains unknown.  Epidemiologists will be researching for years to come whether the Covid-19 lockdowns increased the likelihood of surges of other diseases or that catching Covid-19 has made children more susceptible to other illnesses.  Who knows?  What we do know is Covid is here to stay.  Period.  In all its variants.  When Covid combines with other viruses, our children are simply miserable.

Beyond the “tripledemic,” we are seeing an increase in illnesses caused by Group A streptococcus, a bacteria also known as strep A.  Strep A is not usually life-threatening:

it might simply cause a sore throat or tonsillitis.  In rare cases, it can cause invasive, potentially deadly infections including meningitis.  These are highly unusual but knowing when to look for strep throat and diagnosing strep throat accurately is important.

I’ll go a step further.

Making sure that your children are fully vaccinated with the typical childhood vaccines may help to prevent your baby from getting sicker.  How?  We want healthy children.  We want to keep preventable illnesses from entering and affecting them.  If we can make sure they have the necessary “tools” to fight RSV, flu and Covid, then we can prevent the secondary illnesses like strep and ear infections from resulting.

And this is when we come to a problem, one that my readers no doubt believe is limited to Third World countries only.

The shortage of antibiotics.  Especially for children.  And the shortage of acetaminophen and ibuprofen which help to reduce fevers, headaches and body aches.

Let’s start with the latter.

A fever is a good thing.  It is actually a friend to your child’s body.  Why?  The fever itself is a sign your child’s immune system is working as it should. In fact, fevers help kill the bacteria and viruses that are making your child sick.  For this reason, a reading above 98.6 degrees Fahrenheit doesn’t necessarily always warrant medication. Your pediatrician may tell you that there’s no need to treat your little one’s fever unless your child is uncomfortable (i.e., not eating, drinking, playing or sleeping normally).

If your child has a 103 fever and is running around, do not panic.  They don’t need medication.  Only give the medication if the child is feeling poorly.  Keep them hydrated and try to feed them good, old-fashioned chicken soup.  Make sure they urinate at least one every 5-6 hours.  If they have a history of a febrile seizure, then be vigilant in keeping the fever low.

However, reach out to your pediatrician immediately if your baby is under 8 weeks of age and is running a fever of 100.4 Fahrenheit or higher on a rectal thermometer; is under 2 years and has a fever lasting more than 24 hours; is older than 2 years and has a fever lasting more than 72 hours; or if his/her fever goes higher than 104 degrees repeatedly or is accompanied by other symptoms, no matter his/her age).

When it comes to the Tylenol and Motrin shortages, there are options available.

There are lukewarm baths, lightweight clothes, keeping the child hydrated and running a fan nearby.  Generic versions of medication are possible alternatives to name brands like Advil and Tylenol.  Please do NOT give children under 18 years of age aspirin—whether that be whole, crushed up or halved—because it can lead to Reye’s Syndrome, a potentially fatal condition that causes sudden liver problems and brain damage.

More problematic are the antibiotics shortages.  Older kids and adults know how to swallow pills which opens up the list of medication possibilities.  Kids don’t have these options.  This is why you may hear your physician dialoguing with the pharmacist about options available and what’s in stock.

There are many causes to this shortage.  According to the Food and Drug Administration (FDA), “drug shortages can occur for many reasons, including manufacturing and quality problems, delays, and discontinuations.”  This statement fails to mention the difficulties in acquiring raw materials, manufacturing problems, regulatory issues, business decisions, and disturbances within the supply chain.

Both generic and branded drug manufacturers are obligated to provide FDA information on supply disruptions.  The FDA works closely with them to prevent or reduce their impact. It is only recently that companies forced by the FDA to follow up on their obligation have been obligated to report steep rises in demand to the agency.

Some of the shortages are surely due to the pandemic.  There have been reports that many of the sources for the raw materials are located in countries that because of pandemic, were closed to travel.  Now that borders have reopened, the FDA has resumed its site inspections.  The FDA is making sure that its standards of safety are met.  This may contribute to the shortages.  What a Catch-22.

However, there have been shortages of important generic drugs – both prescription and over-the-counter (OTC) – over the years.  In 2010, the FDA reported 178 drug shortages in cancer drugs, anesthetics used in surgery and many medicines given intravenously.  Today, there are 123 drugs in short supply.  An inadequate of raw materials is one factor in common between the two shortages.  Let’s be frank – The Medical supply chain is opaque on a good day.

My pharmacist friends and colleagues inform me that the shortages will be here for some time.  They may even become more acute.

Ask your pharmacist which antibiotics are available.  Is your pharmacist able to compound medications?  What would be second and third choice antibiotics that are available?  My team and I have had to go this route to make sure our patients are cared for.

This is a world that changes by the nano-second.  Davening becomes even more important.

As always, daven.  But daven even harder now.  Please.

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.