Why children’s medicines are especially exposed to shortages
The winter of 2022 exposed how thin the supply of basic paediatric antibiotics had become. The structural reasons have not gone away.
In brief
Why children’s medicines such as liquid amoxicillin run short: few makers, thin margins and volatile demand, and how regulators are responding.
- Paediatric formulations are often made by few manufacturers on thin margins.
- Liquid antibiotics ran short in the US and Europe during the 2022–23 winter.
- Policy responses focus on stockpiles, early warning and incentives for resilient supply.
In late 2022, families and pharmacists across the US and Europe ran into the same problem: liquid amoxicillin, one of the most commonly prescribed antibiotics for children, was hard to find. In the UK the shortage coincided with a surge of Strep A infections and a sharp rise in demand for penicillin-class antibiotics.
Why paediatric products are fragile
Children’s formulations are frequently low-volume, low-price generics. Oral suspensions are more complex to make than tablets and are often produced by only a handful of manufacturers. When margins are thin, there is little spare capacity, and a single plant problem or demand spike can tip the market into shortage.
Demand for paediatric antibiotics is also seasonal and volatile. Respiratory infections in children surged in many countries after pandemic restrictions eased, and the supply chain was not sized for it.
Substitutes are harder for children
When an adult tablet runs short, a pharmacist can often switch to another strength or a related drug. For a young child who cannot swallow tablets, the options are narrower. Crushing tablets or compounding a liquid in the pharmacy is possible, but it takes time and introduces dosing uncertainty.
The policy response
The episode pushed shortages up the agenda. The EU published a list of critical medicines and began work on measures to strengthen supply of them, including better monitoring and joint procurement. Regulators on both sides of the Atlantic have encouraged earlier notification of supply problems and flexibility on things like importing stock licensed elsewhere.
What has proved harder is the economics. Unless procurement rewards reliable supply rather than only the lowest price, manufacturers have little reason to invest in redundancy for cheap paediatric products.
