As critical drug shortages continue to be a concern across Canada, the Canadian Paediatric Society (CPS) has outlined some guidelines to help health-care providers ensure that children have access to safe and secure supply of necessary medications.
In a report released Thursday, the Canadian Pediatric Society, said that the current “critical” drug shortages are expected to last several months, “and new supply challenges may emerge as “prescribers pivot to second- and third-line drugs.”
A first-line drug is the primary choice for treating a condition that has the “least likelihood of causing side effects,” according to APA Dictionary of Psychology, while a second or third-line drug may cause more side effects while trying to treat the same condition
Canadians have been impacted by worsening supply problems of over-the-counter and prescription drugs, with industry experts saying there is a growing list of medications that are running low or out of stock, making it difficult for health-care providers to prescribe medications.
According to the new CPS guidelines, prescribing practices need to “align with the best available evidence” and health-care providers, and policymakers “need to proactively establish a safe, stable, and secure supply of the medications.”
The CPS also recommends “resource-sensitive prescribing” that can optimize care while also helping to conserve “vital supply.”
“It’s an extra burden on the health care provider who is prescribing to find out if the antibiotic that they want to prescribe is even available,” Dr. Earl Rubin, division director of pediatric infectious diseases at the Montreal Children’s Hospital told Global News.
Moreover, amid ongoing drug shortages, Rubin says pivoting to second and third-line drugs happens every day.
“As an example, for strep throat… penicillin or amoxicillin… is our first line. But if it’s not available, there are other options that will treat strep. But we’ll also treat a lot of other bacteria that we don’t need to have the antibiotic directed against,” Rubin added.
The CPS also highlights that “most acute respiratory illnesses are viral and do not require antibiotics,” so “patients presenting with viral syndromes should not be prescribed antibiotics.”
“We don’t use an antibiotic for a virus. Antibiotics are meant for bacteria,” Rubin said.
The CPS guidelines further stress that while “modest evidence” exists to support the use of macrolide antibiotics like azithromycin or erythromycin for an anti-inflammatory effect in very specific cases of pneumonia, sinusitis, pharyngitis or tonsillitis, they are still not recommended.
“There is no evidence that macrolides play a significant role in moderating inflammation in uncomplicated pediatric respiratory illness,” the CPS said.
When it comes to bacterial infections, Rubin says the ideal approach to treatment it is to have an antibiotic that is attacking the most likely bacteria causing the infection, without having to harm other organisms in the body.
“If there is the broad use of broad-spectrum antibiotics, you will be faced with bacteria that are resistant,” he said, adding that first-line antibiotic recommendations are the best at narrowing the focus on the illness-causing bacteria.
Apart from drug shortages, Canadians are also having to deal with longer hospital wait times, but the CPS in its latest guidelines has cautioned against virtual care in some cases.
“Virtual care increased significantly during the pandemic. While considered safe and effective in many clinical circumstances, scenarios remain where virtual care is inappropriate,” the CPS said.
“Acute otitis media, pneumonia, Group A streptococcal (GAS) pharyngitis, and most urinary tract infections cannot be reliably diagnosed without a physical exam,” it warned.
While Rubin acknowledges that virtual care has become a big part of clinical practice, he says it’s still not appropriate when it comes to prescribing antibiotics.
“It’s not necessarily appropriate to prescribe over the phone without examining the ear of a child with a bacterial infection or without examining the chest,” he said.
Rubin says that while the society’s recommendations are helpful, he believes it’s a “more common-sense approach to things” that helps when it comes to explaining situations to families.
When it comes to dosage, the CPS recommends providers prescribe medication “rounded to a dose that can be dispensed in tablet or capsule form whenever possible and appropriate,” adding that “certain tablets can be split or crushed to ensure the appropriate dose is administered.”
“Pharmacists may instruct families to mix a crushed tablet with milk, juice, other cold liquid or with pudding or ice cream (depending on the medication) to mask the taste,” it said.
“While rolling shortages are expected to continue, it is important for physicians to be aware of the availability of commonly prescribed medications in their community.”
“It is challenging for pharmacists to contact physicians when a prescribed medication is not available. This additional step delays care and demands extra time from all care providers,” it added.
Rubin says he follows that routinely.
“Personally, I need to find out which pharmacy has the prescription in stock so that we don’t just hand the patient a prescription and have them deal with phone calls saying it’s not available,” said Rubin.
As well, Rubin clearly indicates on the prescription that “the pharmacist can also contribute in terms of offering alternatives if not available.”
He says he tries to see if it’s possible to have the recommended dose for the medication as a tablet or capsule that a child can crush or ingest more easily.
“I hope that…parents try and teach their children who are over five or six to learn how to swallow pills as well,” since the CPS maintains that “children and youth should be encouraged to learn how to swallow pills when they are old enough and readily able to do so.”
“Several effective online resources are available to help patients learn this valuable skill,” the CPS guideline said.
“By directing parents to administer tablets or capsules when appropriate, prescribers and pharmacists help preserve the limited supply of liquid formulations for the patients who most need them.”