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 received this message from a colleague, subscribe now.

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.



  • Sanford Guide is hosting a Virtual Open House from September 22-24, beginning with a COVID-19 Panel Discussion with members of our editorial board. Other sessions include product feedback sessions with Jeb Sanford, use of Sanford Guide in the classroom, enterprise licensing, and more.


  • Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.
  • Guidelines on COVID-19 diagnosis, serology, treatment and management, and infection prevention: IDSA and NIH.
  • A living WHO guideline on drugs for COVID-19 (BMJ 2020;370:m3379). The first version of this living guidance focuses on corticosteroids. Available on the BMJ website.
  • Vaccine development pipeline: see COVID-19, Prevention for summary of vaccine development and clinical trials.

New Drug Approvals

  • Nifurtimox* (Lampit), approved by the U.S. FDA for the treatment of Chagas disease (American Trypanosomiasis*), caused by Trypanosoma cruzi, in pediatric patients. Approval is based on serological results from the first part of a double-blind, randomized Phase 3 study conducted in South America; continuation may be contingent upon demonstration of clinical benefit. Recommended dosage (age <18 years): 8-10 mg/kg/day (divided tid) for body weight ≥40 kg; 10-20 mg/kg/day (divided tid) for body weight <40 kg.

New or Updated Treatment Guidelines

  • Clinical practice guidelines for the evaluation, diagnosis, treatment, and prevention of diabetic foot disease, under the leadership of the Jiangsu Medical Association and the Diabetes Society of the Chinese Medical Association (Burns Trauma 2020;8:tkaa017). The guidelines are available at PMC.
  • 2019 update of the European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0 (HIV Med 2020 Sept 3 [Epub ahead of print]). The update is available here.

Practice Pearls

  • There continues to be uncertainty about the impact of non-enzyme-inducing antibiotics on the efficacy of hormonal contraceptives. The argument against the existence of an adverse interaction is based largely on small studies that contain one or more flaws in the way the evidence is interpreted. In a recent analysis of 173,073 spontaneous reports submitted to the UK’s Medicines and Healthcare products Regulatory Agency, unintended pregnancies were seven times more commonly reported with non-enzyme-inducing antibiotics compared to control medicines. No increase in secondary outcomes (such as diarrhea) was observed. Given the life-changing nature of an unintended pregnancy, these data support advising women to take extra conceptive precautions during a course of antibiotics, despite recent recommendations to the contrary (BMJ Evid Based Med 2020 Aug 18 [Epub ahead of print]).
  • We normally think of intravenous acyclovir as a drug administered by intermittent infusion. However, the drug exhibits time-dependent pharmacodynamics vs. herpes simplex virus (HSV), which supports administration by continuous infusion. This report describes two cases of confirmed or suspected neonatal HSV encephalitis successfully treated at home with continuous infusion acyclovir (60 mg/kg/day). In both cases, initial treatment with a few days of intermittent acyclovir was followed by administration via continuous infusion to complete 21 days of therapy, allowing for earlier hospital discharge. No treatment-related adverse effects were observed (Pediatr Infect Dis J 2020;39:830).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of September 13, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since August 9None
    • Shortage recently resolvedBacitracin ophthalmic ointment, Daptomycin injection, Griseofulvin oral tablets and suspension, Mupirocin calcium 2% cream (Glenmark)
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin 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), Cefotetan injection, Cefoxitin injection, Ceftazidime injection, Ceftazidime/avibactam 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)
      • Methanamine hippurate tablets
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: Metronidazole injection
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline injection
      • Topical (miscellaneous) antibacterials: 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)
    • Antimycobacterial drugs
      • Ethambutol tablets
    • Antifungal, antiparasitic, and antiviral drugs in continued reduced supply:
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection
      • Antiparasitic drugs: Chloroquine tablets, Hydroxychloroquine tablets, Pentamidine isethionate
      • Antiviral drugs: Acyclovir injection, Cidofovir injection
    • Vaccines in coninued reduced supply:
      • Hepatitis B vaccine recombinant, 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: Mupirocin calcium 2% cream (Bactroban [GSK], in June 2020), Bacitracin injection (in February 2020), Interferon alfa-2b (Intron A, in October 2019), Mupirocin calcium 2% nasal ointment (Bactroban Nasal [GSK], in August 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).