June 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 received this message from a colleague, subscribe now.
 

JUNE 2020

SARS-CoV-2 / COVID-19

  • Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.
  • Remdesivir remains the treatment option for severe, hospitalized COVID-19.
  • Guidelines on COVID-19 diagnosis, treatment and management, and infection prevention: IDSA and NIH

IV Artesunate FDA approved

  • Artesunate* for Injection has been approved by the US FDA for the initial treatment of severe malaria in adult and pediatric patients. The recommended dosage is 2.4 mg/kg IV at 0, 12, and 24 hours, and thereafter once daily until the patient is able to tolerate oral therapy. Commercial availability is expected in late 2020.

New or Updated Treatment Guidelines

Practice Pearls

  • Non-renal clearance accounts for about 65% of the total clearance of linezolid. Despite this fact, no dosage adjustment for linezolid in hepatic dysfunction is currently recommended. However, a PK modeling study shows that overexposure may result in patients with liver cirrhosis, suggesting the need for a dosage reduction depending on pathogen MIC (Antimicrob Agents Chemother 2020;64: e00133-20).
  • Trimethoprim inhibits the renal tubular secretion of creatinine, causing a fall in creatinine excretion and an increase in the serum creatinine concentration WITHOUT a change in glomerular filtrate rate (GFR). The mechanism is believed to be the inhibition (by TMP) of drug transporters in the proximal tubule (OCT2, OCT3, MATE1, and MATE2-K) also used by creatinine. The expected magnitude of increase is around 30% (Drug Metab Pharmacokinet 2018;33:103).
  • Published data regarding the effect of ECMO on ceftolozane-tazobactam pharmacokinetics are scant. An investigation using both an ex vivo and an in vivo (porcine) model found minimal circuit sequestration and a modest decrease in ceftolozane and tazobactam clearance. The data suggest that no change in ceftolozane-tazobactam dosing in patients undergoing ECMO is warranted, but this recommendation requires confirmation (J Transl Med 2020;18:213).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of June 10, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since May 10Acyclovir injection, Ethambutol tablets, Metronidazole injection
    • Shortage recently resolvedGentamicin ophthalmic ointment
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Gentamicin injection, Tobramycin injection, Tobramycin lyophilized powder for injection
      • Carbapenems: Meropenem injection
      • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Apollo Pharmaceuticals and its distributor FFF Enterprises. Click here for details), Cefoxitin injection, Ceftazidime injection, Cefuroxime injection
      • Clindamycin injection
      • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides: Vancomycin injection
      • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin 0.5% ophthalmic ointment
      • Methanamine hippurate tablets
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: None
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline injection
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Neomycin and Polymyxin B sulfates GU irrigant, Neomycin and Polymyxin B sulfates and Dexamethasone ophthalmic ointment, Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal, antiparasitic, and antiviral drugs in continued reduced supply:
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets and suspension
      • Antiparasitic drugs: Chloroquine tablets, Hydroxychloroquine tablets, Pentamidine isethionate
      • Antiviral drugs: Cidofovir injection
    • Vaccines in coninued reduced supply:
      • 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: 
    • Recent discontinuations: Bacitracin inection (in February 2020), Interferon alfa-2b (Intron A, in October 2019), Quinidine gluconate IV (in December 2017), 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).