Strep A antibiotic shortage sparks calls for pharmacists to get powers to dish ... trends now
Pharmacists who've ran out of antibiotics should be allowed to dish out alternatives to sick kids this winter, top experts demanded today as Strep A continues to sweep the country.
Current rules mean pharmacies can only dispense the medicines GPs have actually prescribed, unless they seek permission.
GPs now want ministers to urgently consider relaxing legal regulations, with the UK currently battling local shortages of several antibiotics routinely given to children with Strep A symptoms.
It comes as a 12-year-old in Hove has become the latest confirmed Strep A death.
What is Strep A?
Group A Streptococcus (Group A Strep or Strep A) bacteria can cause many different infections.
The bacteria are commonly found in the throat and on the skin, and some people have no symptoms.
Infections caused by Strep A range from minor illnesses to serious and deadly diseases.
They include the skin infection impetigo, scarlet fever and strep throat.
While the vast majority of infections are relatively mild, sometimes the bacteria cause an illness called invasive Group A Streptococcal disease.
What is invasive Group A Streptococcal disease?
Invasive Group A Strep disease is sometimes a life-threatening infection in which the bacteria have invaded parts of the body, such as the blood, deep muscle or lungs.
Two of the most severe, but rare, forms of invasive disease are necrotising fasciitis and streptococcal toxic shock syndrome.
Necrotising fasciitis is also known as the 'flesh-eating disease' and can occur if a wound gets infected.
Streptococcal toxic shock syndrome is a rapidly progressing infection causing low blood pressure/shock and damage to organs such as the kidneys, liver and lungs.
This type of toxic shock has a high death rate.
It would mirror protocols brought in earlier this year when thousands of menopausal women struggled to access their regular HRT medication and pharmacists were allowed to offer an alternative version.
The move could ease pressure on busy doctors and provide youngsters with access to available drugs more quickly.
While Strep A is a usually mild bacterial infection, fifteen children have died since September from an exceptionally rare complication it can lead to, called invasive Group A Streptococcus (iGAS).
Health chiefs say the death toll is unusually high for this time of year and experts fear worse is to come in the weeks ahead.
More than 650 cases of iGAS have been detected in England this season, 60 of which have been fatal. This includes 170 cases among children, which have led to 13 deaths. A further two iGAS fatalities have been logged in Wales and Northern Ireland.
But Strep A infections are easily treated if antibiotics are prescribed early enough.
In order to get a grip on the crisis, doctors have been told to dish out antibiotics for Strep A – which include penicillin and amoxicillin - if they suspect a child might be infected.
Symptoms can include a sore throat, headache, fever, nausea and vomiting.
But, parents have told of how their infected children have been unable to access any of the drugs.
Pharmacists have said they have turned patients away, as they don’t have the correct antibiotics to fill their prescription.
Fresh NHS guidance this week even advised doctors to prescribe children tablet versions of the antibiotics, to then be crushed and sprinkled into food, amid local shortages of the liquid option.
The Government has, however, insisted there is no national shortage.
Wholesalers say there are plenty of stock in the country, with distribution problems being blamed for the lack of supply to some pharmacies and hospitals.
MailOnline this week revealed that nine different antibiotics were listed as being in low in stock. The problem, triggered by supply chain issues and a surge in demand, could rumble on until the New Year.
A top doctor today said that giving pharmacists power to alter prescriptions could ease some of the current pressure.
Professor Kamila Hawthorne, chair of the Royal College of GPs, said the current outbreak of the Strep A bacterial infection among children highlighted the need for the rule change.
The GP in South Wales said rules stopping pharmacists from altering prescriptions ‘need to be looked at’.
She said: ‘Not only do pharmacists need to be able to dispense a different formulation of that antibiotic, but if that antibiotic is just not available there are other alternatives that are just as good.'
Professor Hawthorne raised the issue this with Dr Susan Hopkins, chief medical advisor at the UK Health Security Agency, and has also discussed the move with Sir Chris Whitty, England’s chief medical officer.
She added: 'It is being discussed. Whether or not it will happen, I don't know.
‘But for the time being, parents should not worry. What would happen [if prescribed antibiotics were out of stock] is the pharmacists would contact the GP, who would then prescribe the alternative.'
The map shows the rate of iGAS per 100,000 people in England between September 12 and December 4. Rates were highest in Yorkshire (1.8) and the South East (1.4)
The UKHSA has logged 6,601 cases of scarlet fever — which is caused by Strep A — between September 12 and December 4 (green line). For comparison, just 2,538 cases had been reported by this point in 2017/18 (thin blue line), which was considered a 'bad' season
Between September 12 and December 4, the UKHSA was notified of 659 iGAS cases (grey line). Rates are currently higher than the previous five winters
Fears over Strep A infections in children come as several of winter bugs with similar symptoms are also in active circulation.
While most will resolve without the need for any serious medical intervention, for worried parents the official advice on when, and from whom, to seek help is the following:
As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement.
You should contact NHS 111 or your GP if:your is sick and is getting worse your child is feeding or eating much less than normal your child has had a dry nappy for 12 hours or more or shows other signs of dehydration your baby is under 3 months and has a temperature of 38°C, or is older than 3 months and has a temperature of 39°C or higher your baby feels hotter than usual when you touch their back or chest, or feels sweaty your child is very tired or irritable
You should call 999 or go to straight to A&E if:your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs there are pauses when your child breathes your child's skin, tongue or lips are blue your child is floppy and will not wake up or stay awak
Professor Hawthorne said current regulation means pharmacists can't dispense something different to what is written on a patient's prescription from their GP.
It comes as the NHS is ramping up Strep A antibiotic deliveries to chemists across the nation in a bid to tackle local shortages.
David Webb, NHS England’s chief pharmacist, admitted that there may be a ‘temporary interruption of supply of some relevant antibiotics due to increased demand’.
In a letter to pharmacists across the country yesterday, he said some chemists and wholesalers have limited supply, especially for phenoxymethylpenicillin.
But manufacturers of the drug have plenty of stock and are quickly sending out deliveries to wholesalers and pharmacies, Mr Webb said.
He urged pharmacies to work together to understand the local availability of the drugs and to order additional stock ‘sensibly’ in line with patient demand. Ordering ‘excessive quantities’ will only put more pressure on the supply chain, Mr Webb said.
He added that the health service is ‘working closely’ with the Department of Health and Social Care, ‘which has overall responsibility for medicines supply and has taken actions to help ensure medicines continue to be available’.
However, parents have told of their stress in trying to access the antibiotics for their ill children.
Tif Dickinson, from Plymouth, told The Guardian that she had to phone six local pharmacies until she got one bottle of antibiotics – half the amount a GP prescribed to treat her 10-year-old daughter’s Strep A infection.
One chemist told her that it was not expected more stock until