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J Pediatr. 2018 Aug;199:65-70. doi: 10.1016/j.jpeds.2018.04.008. Epub 2018 May 8.

Prescription Drug Shortages: Implications for Ambulatory Pediatrics.

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Emergency Medicine and Trauma Center, Children's National Health System, Washington, DC. Electronic address:
The Center for Healthcare Innovation and Policy Research, George Washington University, Washington, DC.
Department of Pediatrics and Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC.
Drug Information Service, University of Utah Health, Salt Lake City, UT.
Department of Pediatrics, Integrative Systems Biology, Pharmacology & Physiology, George Washington University School of Medicine and Health Sciences/Children's National Health System, Washington, DC.
Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.



To describe contemporary drug shortages affecting general ambulatory pediatrics.


Data from January 2001 to December 2015 were obtained from the University of Utah Drug Information Service. Two pediatricians reviewed drug shortages and identified agents used in ambulatory pediatrics. Shortage data were analyzed by the type of drug, formulation, reason for shortage, duration, marketing status, if a pediatric friendly-formulation was available, or if it was a single-source product. The availability of an alternative, and whether that alternative was affected by a shortage, also was noted.


Of 1883 products in shortage during the study period, 314 were determined to be used in ambulatory pediatrics. The annual number of new pediatric shortages decreased initially but then increased to a high of 38 in 2011. Of the 314 pediatric shortages, 3.8% were unresolved at the end of the study. The median duration of resolved shortages was 7.6 months. The longest shortage was for ciprofloxacin 500-mg tablets. The most common class involved was infectious disease drugs. Pediatric-friendly dosage forms were affected in 19.1% of shortages. An alternative agent was available for 86% drugs; however, 29% of these also were affected. The most common reason for shortage was manufacturing problems.


Drug shortages affected a substantial number of agents used in general ambulatory pediatrics. Shortages for single-source products are a concern if a suitable alternative is unavailable. Providers working in the ambulatory setting must be aware of current shortages and implement mitigation strategies to optimize patient care.


ambulatory medicine; drug shortages; outpatient; pediatrics

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