February ID Update

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal. If you would like to automatically receive our monthly ID Updates by e-mail, subscribe now.


New Drug Approvals

  • Biktarvy* (bictegravir, emtricitabine, tenofovir alafenamide) for the treatment of HIV-1 infection in adults with no prior antiretroviral treatment history, or to replace the current regimen in a patient virologically suppressed on a stable regimen for at least three months with no history of treatment failure or known substitutions associated with resistance to bictegravir, emtricitabine, or TAF. Recommended dosage: one tablet once daily, with or without food.
  • Symfi Lo* (efavirenz, lamivudine, tenofovir disoproxil fumarate) for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 35 kg. Recommended dosage: one tablet once daily on an empty stomach, preferably at bedtime to improve tolerability of CNS side effects.
  • Firvanq (vancomycin oral solution), indicated for the treatment of C. difficile* associated diarrhea in adults and pediatric patients <18 years of age, and also for the treatment of enterocolitis caused by Staph. aureus (including MRSA) in adults and pediatric patients <18 years of age. Product availability: kits containing vancomycin powder (3.75, 7.5, 10.5, or 15 gm) and grape-flavored diluent that provide final drug concentrations of 25 mg/mL and 50 mg/mL after reconstitution. Expected product launch: early April, 2018.

New FDA-approved Indications

  • Ceftazidime-avibactam* is now indicated for the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Serratia marcescens, Proteus mirabilis, Pseudomonas aeruginosa, and Haemophilus influenzae in patients 18 years of age or older. The drug was previously approved for complicated intra-abdominal infection (in combination with metronidazole) and complicated UTI, including pyelonephritis.

From the Centers for Disease Control and Prevention

  • February 9 CDC update on widespread influenza activity, including an audio recording. Click here.
  • Weekly US Influenza Surveillance Report. Click here.
  • The 2018 recommended immunization schedule for children and adolescents aged 18 years or younger. Click here.
  • The 2018 recommended immunization schedule for adults aged 19 or older. Click here.
  • Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) and CDC regarding prevention of hepatitis B infection in the US (MMWR Recomm Rep 67:1, 2018). Available for download here.

Newly Released Treatment Guidelines

  • Clinical guidelines for the diagnosis and treatment of catheter-related bloodstream infection from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) (Med Intensiva 42:5, 2018). The last Spanish catheter-related infections guidelines were published in 2004. The new guidelines are available for download on the SEIMC and SEMICYUC websites.
  • 2017 update of the German clinical guideline on epidemiology, diagnostics, therapy, prevention, and management of uncomplicated urinary tract infections in adult patients (Urol Int 2018 Jan 17 [Epub ahead of print]). This is an update of the 2010 version and is available for download on the Karger website.
  • 2017 update of the guideline for epidemiology, diagnosis, and treatment of adult patients with nosocomial pneumonia from the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology (Pneumologie 72:15, 2018). This is an update of the 2012 version.
  • Guidelines for the diagnosis and treatment of community-acquired pneumonia in adults who present to the hospital from the Dutch Working Party on Antibiotic Policy in collaboration with the Dutch Association of Chest Physicians, the Dutch Society for Intensive Care, and the Dutch College of General Practitioners (Neth J Med 76:4, 2018). These guidelines update the 2011 version and are available for download on the journal website.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Azithromycin injection, Oseltamivir oral suspension
    • [Shortage recently resolved]: Penicillin G benzathine
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Tobramycin injection
      • Cephalosporins: Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin oral suspension, Moxifloxacin injection, Ofloxacin 0.3% ophthalmic solution
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R), Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Clindamycin injection, Doxycycline injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • Vaccines: Hepatitis A Virus Vaccine Inactivated (Vaqta), Hepatitis B vaccine recombinant, Yellow Fever vaccine (unavailable)
  • Antimicrobial drugs newly discontinued: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
    • Recent discontinuations: Terbinafine granules (in May 2017), MenHibrix (in February 2017), Elvitegravir (Vitekta, in December 2016), Peginterferon alfa-2b (in February 2016; 50 mcg vials still available in limited quantities), Boceprevir (in December 2015), Permethrin 1% topical lotion (in September 2015)
  • For detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages