September 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.

September 2018

Sanford Guide App Upgrades

  • In the next few weeks, Sanford Guide mobile app users will begin receiving content updates in real time, replacing our monthly content update cycle. This will allow users to access new guidelines as soon as our editorial board publishes them, and eliminate interruptions by downloading updates in the background. Keep an eye out for app updates and download the latest versions to begin utilizing this new functionality as it becomes available. Tutorials for our mobile apps are available on our YouTube channel.

Drug Safety Communications

  • Based on its recent review, the US FDA is strengthening the current warnings in the prescribing information that fluoroquinolone antibiotics may cause significant decreases in blood sugar and certain mental health side effects. These labeling changes are required only of systemic fluoroquinolone formulations. Blood sugar disturbances are already included as a warning in most fluoroquinolone drug labels; the FDA is adding that hypoglycemia can lead to coma. The new label changes will make the mental health side effects of fluoroquinolones more prominent and more consistent; side effects to be added or updated across all the fluoroquinolones are disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium. The full Drug Safety Communication can be found here.

New Drug Approvals

  • Xerava (eravacycline*), a tetracycline-like drug approved for the treatment of complicated intra-abdominal infections in patients 18 years of age and older. The recommended dosage is 1 mg/kg (over 60 minutes) IV q12h x4-14 days depending on infection severity and clinical response. Product availability: 50 mg single-dose vials.
  • Pifeltro (doravirine*), a non-nucleoside reverse transcriptase inhibitor (NNRTI) approved for the treatment of HIV-1 infection (in combination with other antiretroviral agents) in treatment-naive adults. The recommended dosage is 100 mg orally once daily, with or without food. Product availability: 100 mg film-coated tablets.
  • Delstrigo*, a fixed-dose combination product of doravirine (100 mg), lamivudine (300 mg), and tenofovir disoproxil fumarate (300 mg), approved for the treatment of HIV-1 infection in treatment-naive adults. The recommended dosage is one tablet orally once daily, with or without food. Product availability: film-coated tablets.
  • Moxidectin*, an antihelmintic approved for the treatment of onchocerciasis due to Onchocerca volvulus in patients 12 years of age and older. The recommended dosage is a one-time dose of 8 mg, taken with or without food. Product availability: 2 mg tablets.

New or Updated Treatment Guidelines

  • Updated clinical practice guidelines for antimicrobial prophylaxis in adult patients with cancer-related immunosuppression, from the American Society of Clinical Oncology in partnership with the Infectious Diseases Society of America (J Clin Oncol 2018 Sept 4 [Epub ahead of print]). This release updates the 2013 guidelines and is available on the JCO website.
  • Recommendations for routine use of the seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children, from the American Academy of Pediatrics (AAP) for the upcoming 2018-2019 season (Pediatrics 2018 Sept 3 [Epub ahead of print]). The recommendations are available on the AAP website.

From CDC

  • The 2018–19 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the US have been released (MMWR Recomm Rep 2018; 67(No. RR-3):1–20. Routine annual vaccination of all persons aged ≥6 months without contraindications continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. Other important updates:
    1. Vaccine viruses will be an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).
    2. For the 2018–19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 (not recommended the last two seasons) is an option for those for whom it is appropriate. Note: IIV=inactivated influenza vaccine, RIV=recombinant influenza vaccine, LAIV=live attenuated influenza vaccine; 4=quadrivalent vaccine.
    3. Persons with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine (IIV, RIV4, or LAIV4) that is otherwise appropriate for their health status. Additional recommendations concerning vaccination of egg-allergic persons are discussed.
    4. Recent licensure and labeling changes are reviewed, including expansion of the age indication for Afluria Quadrivalent (IIV4) from ≥18 years to ≥5 years and expansion of the age indication for Fluarix Quadrivalent (IIV4), previously licensed for ≥3 years, to ≥6 months.

    The full report is available on the MMWR 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]: Daptomycin
    • [Shortage recently resolved]: Moxifloxacin injection
    • [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 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
      • Penicillins: Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Clindamycin injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension, 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)