Cephalexin use in a pediatric emergency department during the shortage of amoxicillin suspension

Purpose

During a significant shortage of amoxicillin suspension in Canada in late 2022, local guidelines recommended cephalexin as an alternative with restricted use of amoxicillin-clavulanate (AC). The aim of the study was to determine outcomes of patients with a diagnosis of acute otitis media (AOM), community acquired pneumonia (AOM) and pharyngitis who were prescribed cephalexin compared to other antibiotics in the emergency department (ED).

Materials and methods

We conducted a retrospective cohort analysis of pediatric patients diagnosed with AOM, CAP, and pharyngitis who received antibiotic prescriptions upon discharge from the ED between July 2020 and June 2023. Cases were identified using ICD-10 diagnostic codes, and data were extracted from the EPIC™ electronic health record system. We compared return visits within 3 days and 21 days of the index encounter as measures of potential treatment failure and adverse events, respectively.

Results

Among 7387 eligible patient encounters, cephalexin and AC emerged as the most frequently prescribed alternatives to amoxicillin during the shortage period. Comparative analysis revealed no statistically significant differences in the rates of return visits or adverse events within 21 days post-treatment initiation across the different antibiotic regimens.

Conclusions

Cephalexin represents a suitable alternative for AOM, CAP, and pharyngitis during an amoxicillin shortage, with potential antimicrobial stewardship benefits due to its narrower spectrum.