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Strep A: Five more ‘serious shortage protocols’ issued for penicillin as cases surge

Around 19 children are thought to have died from infections caused by the bacterium as cases rose 27 per cent in the last week

Emily Atkinson
Saturday 17 December 2022 14:47 GMT
Strep A: Asda chair says antibiotics supply in pharmacies 'thinner' than he'd prefer

The government has issued a second wave of emergency rule changes to allow pharmacists to supply alternative medicines to treat Strep A infections, in an effort to cope with antibiotic supply problems as cases surge.

It comes as the latest data from the UK Health Security Agency (UKHSA), released on Thursday, showed that the number of life-threatening infections caused by the bacterium had risen by 27 per cent in the previous week.

Meanwhile, there are currently three times more cases of scarlet fever than usual, a senior health official has said.

Strep A infections, including scarlet fever and impetigo, are treated with antibiotics, and penicillin is among the most commonly used. But the increase in infections has hit the NHS during its busiest period, with pharmacies facing localised shortages of antibiotics, leaving parents struggling to find medicine for their sick children.

The five new serious shortage protocols (SSPs) allow pharmacists to provide patients with alternatives if they don’t have the medicine for a particular prescription in stock.

In a statement, the Department of Health and Social Care (DHSC) said: “Demand for penicillin has risen recently as it is used to treat Strep A and scarlet fever, and the increased demand means that some pharmacists are experiencing temporary and localised supply issues and may not have the specific formulation listed on the prescription.”

It comes after the government announced on Thursday afternoon that it had issued SSPs across the UK for three penicillin medicines because of the high demand.

The SSPs are intended to help mitigate the local supply issues affecting oral penicillin, and will allow pharmacists to supply alternative forms of the medicine from that stated on the prescription.

Health authorities say that cases of both scarlet fever and the life-threatening invasive Group A Streptococcus (iGAS) have increased this year.

At least 19 children have died across the UK from invasive Strep A infections, new figures show, while the government has acknowledged that there are supply issues affecting some of the drugs used to treat related illnesses.

Stella-Lily McCorkindale, Hannah Roap and Muhammad Ibrahim Ali all died after Strep A infections (PA/Family handout)

Concern has been raised as cases are higher than usual for the time of year. The latest data from the UKHSA, released on 15 December, showed that the number of iGAS infections had risen by 27 per cent in the previous week.

Announcing Thursday’s round of SSPs, health minister Will Quince said: “The increased demand for the antibiotics prescribed to treat Strep A has meant some pharmacists have been unable to supply the medicine shown on the prescription.

“These serious shortage protocols will allow pharmacists to supply an alternative form of penicillin, which will make things easier for them, patients, and GPs.

“We are taking decisive action to address these temporary issues and improve access to these medicines, by continuing to work with manufacturers and wholesalers to speed up deliveries, bring forward stock they have to help ensure it gets to where it’s needed, and boost supply to meet demand as quickly as possible.”

In other news, professor Susan Hopkins, chief medical adviser at the UKHSA, announced today that scarlet fever case numbers are around three times higher than usual for this time of year.

In a bid to quell parents’ concerns, she said that the vast majority of children affected have a mild illness and that an “open mind” is being kept as to why there is a spike in infections.

Speaking on BBC Radio 4’s Today programme, she said: “The latest with scarlet fever and Strep A infections is that we’ve seen just over 7,500 notifications of scarlet fever, and that’s probably an underestimate. We have a lot of reports coming in in the last few days, so we expect it to be even higher.

“That’s about three times higher than the same time in a normal season. The last bad season we had was in 2017 and 18.

“And in invasive Group A Strep cases, we are more than halfway through what we’d normally see in an average season. We’ve seen 111 cases in children aged one to four, and 74 cases in children aged five to nine.”

The five new SSPs apply to the following medicines:

  • Phenoxymethylpenicillin 125mg/5ml oral solution
  • Phenoxymethylpenicillin 125mg/5ml oral solution sugar-free
  • Phenoxymethylpenicillin 250mg/5ml oral solution
  • Phenoxymethylpenicillin 250mg/5ml oral solution sugar-free
  • Phenoxymethylpenicillin 250mg tablets


Advice from UK Health Security Agency on Strep A:

The first signs of scarlet fever can be flu-like symptoms, including a high temperature, a sore throat, and swollen neck glands (a large lump on the side of your neck).

A rash appears 12 to 48 hours later. It looks like small, raised bumps and starts on the chest and tummy, then spreads. The rash makes your skin feel rough, like sandpaper. The rash will be less visible on darker skin but will still feel like sandpaper.

Contact NHS 111 or your GP if:

  • your child 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 38C, or is older than 3 months and has a temperature of 39C 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

Call 999 or go 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 awake

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