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Amoxicillin Shortage
Health Authorities Call
on Compounders to
Support Global
Shortages in
Amoxicillin Suspension

January 24, 2023 | 6 min read

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Shortage of Amoxicillin Suspension

If you work in the pharmacy or have been there lately, you've definitely noticed plenty of shortages, particularly in essential pain and fever medication (check out our blog Partnering with Compounders to Address the Pediatric Acetaminophen Shortage), cold and flu medication, and antibiotics. A drug shortage in itself is not a new phenomenon; it can occur as a result of manufacturing delays, lack of raw ingredients, or a sudden increase in the demand of a medication. What is new, is the recent unavailability of an essential antibiotic used to treat pediatricinfectious diseases – amoxicillin suspension.

Key amoxicillin manufacturers, across the globe, are reporting drug shortages that are anticipated to last several months1,2. Being one of the most commonly prescribed antibiotics for children, the consequences of the unavailability of amoxicillin suspension are huge and can be life threatening. It means that one less first-line therapeutic is available when a child gets sick with respiratory tract infections, which peak in the winter months3. The US Food and Drug Administration (FDA) and the Australian Therapeutic Goods Administration (TGA) – two markets significantly impacted by the current amoxicillin suspension shortage – continue to work with drug manufacturers to secure product, but when supply does come in, pharmacies are often being limited to a small amount per day or per week.

With more and more parents calling their pediatrician or general practitioner to tell them that they can’t find amoxicillin suspension anywhere, healthcare professionals are left scrambling for solutions. In the US, the American Academy of Pediatrics (AAP) recommend turning to other commercial formulations of amoxicillin, such as tablets, capsules or chewable tablets when possible, and suggest rounding to the nearest dose (±10%)4. Tablets can be split or crushed and mixed with a liquid or semisolid, like applesauce4. However, alternatives that require caregiver manipulation such as this leaves room for error, increases risk for cross-contamination, impacts child compliance, and burdens parents and caregivers. Addressing the shortage with options that are appropriate and safe to administer a patient are needed. Compounding pharmacists are uniquely positioned to address this need and healthcare authorities are supporting compounders with guidances to reduce risk and facilitate dispensing.

Compounded Amoxicillin Suspension

Defined as the practice of preparing customizedmedications in accordance with a licensed practitioner’s prescription, pharmaceutical compounding exists to allow providers the opportunity to explore customizedtherapies that are otherwise not commercially available. This includes personalizingdosage strengths, using alternative dosage forms, eliminating unwanted ingredients, combining therapeutics, or filling demands during drug shortages like the one we are currently facing. In this particular instance, where amoxicillin suspension is unavailable, a compounding pharmacist can prepare the suspension in their lab, supporting the demand for this product while on shortage and avoiding challenges with using other commercial forms, notably parents cutting and crushing tablets. Take home – compounders can prepare the specific formulation on shortage.

Recently, the FDA has issued an immediately in effect guidance on the preparation of amoxicillin suspension due to the urgent need of beta-lactam oral suspension preparations5,6. Before the shortage, amoxicillin suspension was not to be compounded due to the availability of the commercial product. However, due to the critical nature of the shortage, this guidance has been set forth to outline steps to reduce the risk of cross-contamination when compounding amoxicillin suspension. It serves as a resource for compounders looking to address the amoxicillin shortage. Similarly, in Australia, the TGA has released the Serious Scarcity Substitution Instrument (SSSI) for amoxicillin to allow pharmacists to dispense a substitute product containing the same active ingredient without prior approval from the prescriber7 – facilitating patient access. Under this act, compounding should not occur when commercial substitutions are available.

Medisca – Partnering to Support Compounders with the Amoxicillin Shortage

As a supplier of pharmaceutical compounding products and services, one of the primary roles of Medisca is to support compounding pharmacies and hospitals during times of shortages. With drug shortages being sky high across the globe, Medisca has been working around the clock to leverage their relationships with qualified manufacturers and suppliers to meet product demand. Medisca compounding services – led by a team of highly skilled formulation chemists, pharmacists, and technical support service representatives – continue to support compounders with formulation design, calculations, preparatory questions, ingredient selection, and much more. Compounding pharmacists can learn more about Medisca Compounding Services here.

Relative to the current amoxicillin suspension shortage, Medisca is currently managing high demand for their oral vehicles (available free of alcohol and sugar):

Aside from the ingredients themselves, compounding formulas are the most essential element to compounding. Like a recipe, they detail all the pertinent information and instructions needed for the pharmacists to prepare compounded preparations. With over 10,000 compounding formulas in our library, Medisca is well-recognized in the industry as the go-to resource for formulation support.

Amoxicillin Formulas – A Complimentary Resource to Support Shortages

Given the critical nature of drug shortages, all shortage-related Medisca formulas are shared with the healthcare community free of charge. Shortage formulas are consolidated on the Medisca Shortage Formulas webpage, formatted in an easy-to-filter-through table. Shortages are continuously monitored across the globe and the Medisca compounding service team proactively develops formulas when possible, to support the need. With pediatricpatients in mind, the below compounding formula was developed in response to the unavailability of amoxicillin suspension. This formula uses 250 mg commercial capsules.

F 009 743 Amoxicillin 250mg/5ml Oral Liquid

In addition to the formulas themselves, we are currently offering free compounding services to support the current amoxicillin suspension shortage – including support with formula searches, preparatory questions, pharmaceutical calculations, and more – to compounding pharmacies and hospitals across the globe. Inquiries can be sent to compoundingservices@medisca.comor phoned in directly to 1-800-665-6334 ext. 1203.

If you are a provider, caregiver, or patient in need of this care, we encourage you to reach out to your local compounding pharmacy.


  1. Tripplaar, K. 2022. Pharmacies are reporting shortages of the widely used antibiotic amoxicillin. NBC News. Retrieved from:
  2. Amoxicillin shortage: antibiotic options for common pediatric conditions. 2022. American Academy of Pediatrics. Retrieved from:
  3. Lee, B.Y. 2022. FDA: Amoxicillin shortage hits U.S., how this antibiotic is misused for respiratory illnesses. Forbes. Retrieved from:
  4. Jenco, M. 2022. New resource provides alternatives to amoxicillin suspension during shortage. American Academy of Pediatrics. Retrieved from:
  5. FDA issues immediately in effect guidance for compounding of amoxicillin to alleviate shortages.2022. State of Ohio Board of Pharmacy. Retrieved from:
  6. Guidance document: compounding certain beta-lactam products in shortage under section 503A of the Federal Food Drug and Cosmetic Act. 2022. FDA. Retrieved from:
  7. Therapeutic Goods Adminastration (TGA). Antibiotics shortages. 2022. Australian Government. Retrieved from:

Amoxicillin Shortage
Non-Sterile Compounding:
A Guide to Primary
Engineering Controls

August 29, 2023 | 5 min read

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Revised USP <795> and Primary Engineering Controls

In November 2022, the long-awaited update to the United States Pharmacopoeia (USP) General Chapter <795> on Non-Sterile Compounding was released. The revisions have many non-sterile compounding pharmacies across the United States buzzing with questions about what necessary changes must be implemented, sparking renewed interest in primary engineering controls (PECs).

PECs are devices employed directly at the point of use1 that control airborne contamination from the working environment2. The USP <795> Chapter calls out specific requirements for PECs used in non-hazardous and hazardous compounding in order to ensure compounder safety and minimize environmental exposure. PECs can be broken down into three main categories2:
  • Containment ventilated enclosure (CVE, i.e., powder hoods).
  • Biological safety cabinet (BSC, i.e., laminar flow hoods).
  • Compounding aseptic containment isolator (CACI).

During the compounding of hazardous drugs, PECs are designed to ensure the containment of hazardous material, hence the name containment PECs (C-PECs)2. But the challenge remains: which PECs to use and how to be compliant with USP Chapters <795> and <800>?.
The regulations surrounding PECs used in non-sterile compounding leave room for interpretation, illumining the importance of implementing best practices. Being compliant is one thing. Applying best practices is another. It is the collective responsibility of all compounders to uphold the integrity of the compounding practice. As you adopt these standards and apply best practices, you'll not only stand out from the competition but, more importantly, position yourself as a preferred partner for physicians seeking collaboration and patients needing your services. After all, physicians look for trusted partners who prioritize quality and patient safety. Patients, in turn, seek reliable pharmacies they can entrust with their health.

Non-Hazardous Compounding

Although the USP <795> does not lay forth specifics on hood selection for non-sterile non-hazardous compounding, it does require that compounding pharmacies perform an evaluation to determine what compounding activities result in powder generation. To better understand where such activities must be conducted in a hood, see the excerpt from the new USP <795> chapter below3:

"Weighing, measuring, or otherwise manipulating components that could generate airborne chemical particles (e.g., active pharmaceutical ingredients [APIs], added substances, and conventionally manufactured products) must be evaluated to determine if these activities must be performed in a closed-system processing device to reduce the potential exposure to personnel or contamination of the facility or CNSPs. Examples of closed-system processing devices include containment ventilated enclosures (CVEs), biological safety cabinets (BSCs), and single-use containment glove bags. The process evaluation must be carried out in accordance with the facility’s SOPs, and the assessment must be documented.”

Interestingly, the USP stops short of clearly defining how to assess powder generation, making it vague. However, if you've ever weighed out stevia and tasted its sweet flavor in the air or seen wisps of ketoprofen dust floating around while compounding, you know for certain that powders can indeed become airborne. By these lines, although the chapter takes a roundabout way of outlining when hoods are required, it is hard to imagine an instance where they should not be required. There is also value in consistency. All powders can generate airborne particles, so rather than evaluate each product (through an undefined, objective method), performing non-sterile, non-hazardous weighing, measuring, and manipulative activities in that same closed-system space would be more straightforward.
It’s important that we do not underscore the importance of taking the precautions to protect the compounder, safeguard the integrity of the preparation, and reduce cross-contamination exposure. Compounding pharmacist and owner with over 25 years of experience, Mark Filosi, said it well:

“We used to think coal dust and sawdust was inconsequential. I don’t want to learn 20 years from now that I should have been using a hood. Also, regardless of the hazard level, a hood does help prevent cross-contamination from one prep to the next. It cuts down on the residue of the previous preparation.”

So, what’s the take-home message? Simple. A PEC should be required for all non-sterile compounding activities. When evaluating which hood, always look for certifications from reputable organizations to ensure that your chosen equipment aligns with USP standards. For instance, the XPert Filtered Balance System Powder Containment Hood by Labconco is a CVE that checks off all of the boxes. It uses a built-in blower and HEPA filter to contain powders during weighing to help ensure the safety of the compounder.

Hazardous Compounding

For hazardous drug compounding, the necessity of a hood is apparent. According to the USP General Chapter <800> on Hazardous Drug Compounding, all activities must be performed in a C-PEC offering personnel and environmental protection through external ventilation or HEPA filtration3. However, when choosing the right hood for your specific compounding activities and compounding space, several factors should be taken into consideration:

  • State Law Requirements: Before deciding on a hood, you must be aware of the specific requirements set forth by your state's laws. For instance, some states may stipulate the need for exterior hood ventilation, while others might leave it to the compounder's discretion. There might also be requirements for features like a waste chute.
  • Anticipated Volume: Reflect on the volume your lab is currently compounding and anticipating to compound to help determine whether you'll need multiple C-PECs for your HD compounding room. Remember, if you plan on having multiple C-PECs inside a containment secondary engineering control (C-SEC; i.e., the room in which the C-PEC is placed), you must respect hood placement and air change per hour (ACPH) requirements. For instance, the USP <800> Chapter mandates that all C-PECs be placed in a negative pressure room with a minimum of 12 ACPH4.
  • Type of Equipment: Keep in mind the equipment you plan to use within the hood, as it will directly affect the available workspace for compounders. It also influences the hood's height, especially if some equipment demands extra clearance.
  • Presence of Fumes: If your compounding activities involve fumes, it is essential to invest in a hood designed with filters to handle them safely and effectively.

With these points in mind, Class I BSCs are designed for personnel and environmental protection by pulling air from the room through the front, away from the operator. They may be externally vented with a single HEPA filter or have two redundant HEPA filters that exhaust back into the room, although USP indicates that the former is preferred3. The RXPert Single Filtered Balance System is an example of a high-quality C-PEC used for hazardous compounding. This Class I BSC is designed to meet the USP <800> standards and features a factory-installed canopy and HEPA filtration.

A Class II BSC used for sterile compounding may be used for occasional non-sterile hazardous compounding but must be decontaminated, cleaned, and disinfected before resuming sterile activities3. A Class II BSC is defined as a ventilated cabinet intended for personnel, product and environmental protection, designed with an open front and inward airflow (personnel protection), downward HEPA-filtered laminar airflow (product protection), and HEPA-filtered exhaust air (environmental protection).

The Medisca Advantage: Service, Selection and Peace of Mind

There are many factors to consider when selecting the proper engineering controls for your compounding pharmacy. Yes, you need to be compliant with USP <795> and USP <800>, but you also need to make sure that the devices you choose fit the needs and future direction of your pharmacy. It all boils down to a few questions:
  1. Are you compounding, and do you plan to continue compounding non-sterile preparations?
  2. What drugs are you handling (i.e., hazardous or non-hazardous)?
  3. What limitations exist regarding costs (i.e., budget) and facility (i.e., compounding space, lease restrictions, building permits, accessibility, outside ventilation, etc.)?

With a team of experts specializing in hood selection for pharmaceutical compounding needs and a portfolio of 40 hoods for non-sterile compounding, Medisca supports compounders in addressing these questions and finding the best-fitted solutions for their specific pharmacy and/or facility needs. Medisca equipment specialists – led by a team of highly trained individuals with years of in-field experience – are here to walk you through all the steps of implementing a USP-compliant hood in your compounding pharmacy.

Ready to embrace best practices and elevate your PECs? Contact an account representative to connect you with an Equipment Specialist today.

Looking for more information on the revised USP General Chapters <795> and <800>? Visit here.


  1. Wagner, JT. Considerations for choosing primary engineering control for compounding sterile products. IJPC 2005; 9(4): 284-290.
  2. Chapter 12: Types of Engineering Controls. The Chapter <800> Answer Book.
  3. <795> Pharmaceutical Compounding – Nonsterile Preparations. United States Pharmacopoeia WebSite. Retrieved from: USPNF/revisions/gc-795-postponement-rb-notice-20191122.pdf
  4. <800> Hazardous Drugs – Handling in Healthcare Settings. United States Pharmacopoeia WebSite. Retrieved from:


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