Strep A: Pharmacists running low on first-choice antibiotics can now give out alternatives

A microscopic image of Strep A - AP
A microscopic image of Strep A - AP

Effective penicillin alternatives can now be prescribed by clinicians to treat Strep A if the first-choice drug is out of stock amid local supply issues at some pharmacies.

New guidance sent out on Friday will allow pharmacists flexibility in ensuring as many patients as possible will now be able to obtain an effective course of antibiotics.

Guidance co-signed by NICE, NHS England, UKHSA, GPs and pharmacists has been sent out to healthcare professionals informing them of the change.

The document will be valid until the end of January and help parents worried about their child having a sore throat and potentially Strep A to get a course of treatment if prescribed by a GP.

The guidance says that phenoxymethylpenicillin (Pen V) remains the first choice drug “due to its high effectiveness, no reported resistance, and narrow spectrum of activity”.

But, if this is unavailable, amoxicillin, macrolides and cefalexin can be given out by pharmacists “in decreasing preference”.

Doctors and pharmacists were getting frustrated that regulations meant they had to turn people away empty handed because a particular prescribed drug was not available when other effective treatments were in stock.

Panasha Desai, a pharmacist at Landys in Temple Fortune, North-West London, had empty shelves and no stock of amoxicillin or Pen V.

“Normally if I want to order 100 bottles of antibiotics in a day I can," she told The Telegraph. “Now, everywhere has nothing.

“We have spoken to lots of other chemists in the area and everyone is experiencing the same thing.”

Amo Sohal, who owns Kitsons Pharmacy in Worcester, also urged the Government to get on top of the supply issues.

"I have never seen this sort of shortage before," he said. "The situation has changed a lot in the last 48 hours.

"People are coming to us with prescriptions that we just can't get hold of from our suppliers.

"It's so difficult when you can't get prescriptions for people who need them. It is a very worrying picture, and we need support."

The Government has repeatedly issued reassurances that there are plentiful supplies of antibiotics that can treat Strep A, despite pharmacists reporting depleted stocks and supply issues.

David Webb, the chief pharmaceutical officer for England, said this week there was “sufficient stock” centrally of antibiotics but admitted some local pharmacies had seen “a temporary interruption of supply”.

It is understood there had been a sharp increase in demand for liquid forms of Pen V, the first choice drug for Strep A, over the last week which had depleted wholesaler stock levels rapidly.

Children can be prescribed tablet antibiotics and parents have been told they can grind up pills and sprinkle them in jam or dissolve tablets in blackcurrant squash to mask the bitter taste of the medicine and help a child take it.

At least 16 children have now died of Strep A after developing a severe form of disease called iGAS. The latest death was in a young child in Hove, authorities said.

A Department of Health and Social Care spokesman said: "There is no supplier shortage of antibiotics available to treat Strep A. As the Secretary of State said, we sometimes have surges for products and increased demand means some pharmacies are having difficulties obtaining certain antibiotics.

“We are working urgently with manufacturers and wholesalers to explore what can be done to expedite deliveries and bring forward stock they have to help ensure it gets to where it’s needed, to meet demand as quickly as possible and support access to these vital medicines.”