March 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.
 

MARCH 2018

 

Sanford Guide to Antimicrobial Therapy 2018

  • New print editions of the Sanford Guide to Antimicrobial Therapy are expected to be available within the next two weeks. To learn more about what updates are included or to pre-order books, visit our Online Store.

Drug Safety Communications

  • The US FDA is advising caution when considering the use of clarithromycin* in patients with heart disease because of the potential for increased long-term risk of heart problems or death. This recommendation is based on a review of the results of a 10-year follow-up study of patients with coronary heart disease from a large clinical trial that first observed this safety issue. The full Drug Safety Communication can be found here.

New Generic Approval

Newly Released Treatment Guidelines

Antibiotic Stewardship

  • Fluoroquinolones* (FQ) are associated with serious toxicities, and the US FDA has recently cautioned prescribers to avoid using them if alternative and effective drugs are available. Nevertheless, a recent study suggests that about 5.1% of adult ambulatory FQ prescriptions are written for conditions such as viral URIs and bronchitis that don’t require antibiotics, and 19.9% are for conditions where FQs are not considered firstline choices (sinusitis and uncomplicated UTI). Antibiotic stewardship efforts should be directed against inappropriate FQ use (Clin Infect Dis 2018 Jan 24 [Epub ahead of print]).
  • Carbapenem-resistant Enterobacteriaceae (CRE), such as carbapenem-resistant Klebsiella pneumoniae (CRKP), is associated with limited treatment options and poor outcomes. In addition, resistance to last-line drugs such as colistin is increasing. In the first report of colistin heteroresistance in K. pneumoniae in the US, two multidrug-resistant CRKP urine isolates deemed colistin susceptible by clinical diagnostics were found to harbor a minor colistin-resistant subpopulation. This subpopulation became dominant when grown in the presence of colistin but returned to baseline levels when grown in media free of colistin. To assess possible in vivo relevance, mice infected with either strain did not survive the infection, even in the presence of colistin. This suggests the possibility of patients with colistin-susceptible CRKP strains failing colistin therapy and underscores the importance of improved diagnostics (MBio 9:e02448, 2018).

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]: Ciprofloxacin injection, Dalbavancin injection
    • [Shortage recently resolved]: Ofloxacin 0.3% ophthalmic solution
    • [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
      • 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: Azithromycin injection, 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: Oseltamivir oral suspension
      • 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/DrugShortages