July 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.

July 2018


New Drug Approval

  • Plazomicin, a new aminoglycoside derived from sisomicin, was approved by the US FDA in late June 2018 for treatment of adults with complicated urinary tract infections (UTIs), including pyelonephritis, caused by these susceptible microbes: E. coli, K. pneumoniae, P. mirabilis, and E. cloacae. The clinical significance of in vitro activity against other gram-negative bacilli is unknown at this time. Activity against P. aeruginosa is variable, and the drug has no activity against A. baumannii, S. maltophilia, or anaerobes. Safety and efficacy data are limited, so Plazomicin should be used only where there are limited or no alternative treatment options. The recommended dosage is 15 mg/kg IV q24h for 4-7 days.

New or Updated Treatment Guidelines

  • Guidelines for proper utilization of the microbiology laboratory for diagnosis of infectious diseases, from the Infectious Diseases Society of America (IDSA) and American Society for Microbiology (ASM) (Clin Infect Dis 2018 June 28 [Epub ahead of print]). These guidelines update recommendations published in 2013 and are available on the IDSA website.
  • Executive summary of clinical practice guidelines (2018 update) for the management of invasive aspergillosis, prepared by The Study Group of Fungal Infections (GEMICOMED) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) (Enferm Infecc Microbiol Clin 2018 June 27 [Epub ahead of print]).

From CDC

  • Updated recommendations for use of once-weekly INH-rifapentine for LTBI. In 2011, CDC recommended 3 months of once-weekly isoniazid and rifapentine (3HP) by directly observed therapy (DOT) for treatment of latent tuberculosis infection (LTBI), with limitations for use in children <12 years and in patients with HIV. Based on a systematic review of published evidence and after consideration of input from TB experts, the Advisory Council for the Elimination of TB, and the public, CDC continues to recommended 3HP for adults with LTBI and now recommends it (1) for persons aged 2-17, (2) for persons with HIV infection, including AIDS, who are taking antiretroviral drugs with manageable drug-drug interactions with rifapentine, and (3) by DOT or self-administered therapy in persons ≥2 years of age. Full discussion: MMWR 67(25): 723-726, 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]: Azithromycin ophthalmic solution 1% (unavailable)
    • [Shortage recently resolved]: Dalbavancin injection, Doxycycline injection, Oseltamivir oral suspension, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R)
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Cephalosporins: Cefazolin, Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Cefpodoxime oral suspension, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin oral suspension, Gemifloxacin tablets, Moxifloxacin injection (unavailable)
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Clindamycin injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • Vaccines: Hepatitis A virus vaccine inactivated (Vaqta), Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), Yellow Fever vaccine (YF-VAX is unavailable, but Stamaril can be obtained through a limited number of clinics in the US. Click here).
  • 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)