Shortage Start: February 2023

Shortage Resolved: Ongoing

Interim Guidance:

• Clinical Considerations: Clindamycin is lincosamide antibiotic with activity against gram-positive organisms and some gram-negative anaerobes, historically used in a variety of skin and soft tissue infections and as adjunctive therapy for toxin-mediation in toxic-shock syndromes
  • Susceptibility to clindamycin is declining for many organisms
  • Locally, susceptibility for Staphylococcus spp. (including MSSA and MRSA) is <80%.
  • Regardless of shortages status, Northern Light Health generally recommends against the use of clindamycin outside of its role in toxin-mediation and is absent from NLH treatment guidelines
• Alternatives (See disease specific guidelines for full recommendations and dosing):
  • Non-purulent SSTIs:
    • Preferred: Cefazolin or cephalexin/cefadroxil always preferred for superior activity v.s. typical skin organisms.
    • True cephalosporin allergy: Sulfamethoxazole-trimethoprim is a reasonable oral option for patients with true cephalosporin allergies as it provides reliable coverage v.s. Staphylococcus spp. and Group A Streptococcus. If IV therapy is required for patients with true cephalosporin allergies, vancomycin is preferred
  • Purulent SSTIs:
    • Preferred: Sulfamethoxazole-trimethoprim or doxycycline provide superior activity v.s. MRSA compared to clindamycin. PO linezolid is also a reasonable option if contraindications to SMX-TMP/doxycycline. If IV therapy is needed, vancomycin is preferred over clindamycin
  • Mediation of Toxin Release (toxic-shock syndrome):
    • Preferred: Clindamycin continues to be preferred.
    • Alternative: This recommendation will be updated with alternatives if clindamycin is no longer available

Shortage Start: November 10, 2022

Shortage Resolved: Resolved early February 2023

Products Impacted: 

• Amoxicillin suspension: 125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL
• Amoxicillin tablets are not affected and remain available to use.

Interim Guidance:

The Northern Light Bug-Drug Guide provides alternative therapeutic recommendations in pediatrics for bacterial pharyngitis, acute otitis media, and pneumonia. Questions regarding the Northern Light Bug-Drug guidelines or antimicrobial therapies can be submitted to your local Antimicrobial Stewardship Team (See your local stewardship contacts here) or submitted to the System Antimicrobial Stewardship Specialist:

Kelly Sawyer, PharmD, BCIDP

This shortage is resolved as there is now adequate supply of amoxicillin suspension.