October 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. To receive these updates via email, subscribe now.





  • 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.
  • Updated guidance on the management of COVID-19 from a joint American Thoracic Society/European Respiratory Society Task Force (Eur Respir Rev 2020;29:200287). This release updates prior guidance from the Task Force on the pharmacological management of acute COVID-19, including remdesivir, HCQ, and dexamethasone. Available at PMC.
  • Vaccine development pipeline: see COVID-19, Prevention for summary of vaccine development and clinical trials.

New or Updated Treatment Guidelines

  • 2020 updated guidelines on diagnosis, management, and prevention of central venous catheter-related infections in hematology and oncology, by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (Ann Hematol 2020 Sep 30 [Epub ahead of print]). These guidelines update the 2012 release and are available on the journal website.
  • 2020 recommendations from the International Antiviral Society-USA Panel regarding the use of antiretroviral drugs for the treatment and prevention of HIV infection in adults (JAMA 2020 Oct 14 [Epub ahead of print]). These recommendations update the 2018 release.

Practice Pearls from the Recent Literature

  • Population pharmacokinetic modeling suggests that in critically ill patients treated with caspofungin, the standard fixed-dose regimen may achieve inadequate drug exposure in all patients weighing ≥120 kg, over 80% of median-weight (78 kg) patients, and about 25% of lower-weight (≤50 kg) patients. A weight-based dosing regimen (2 mg/kg loading dose, then 1.25 mg/kg q24h) might be more appropriate (Antimicrob Agents Chemother 2020;64: e00905-20).
  • In a large, retrospective cohort study from the UK, macrolide use during the first trimester of pregnancy was associated with an increased risk of any major malformation, and specifically cardiovascular malformations, compared to penicillins. Macrolide prescribing in any trimester was associated with an increased risk of genital malformations (BMJ 2020;368:m331).
  • Penicillins, including piperacillin-tazobactam, delay the elimination of high-dose methotrexate by interfering with renal proximal tubular secretion of MTX. Severe toxicity (renal, neurologic, hepatic, hematologic, dermatologic, GI, pulmonary) may result from concomitant use (J Oncol Pharm Pract 2020 Sept 2 [Epub ahead of print]).
  • Hyponatremia is a known but probably underappreciated adverse effect of TMP-SMX. Natriuresis is thought to be the most likely explanation, although a recent report provides evidence more consistent with SIADH (Medicine 2020;99:e20746).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of October 13, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since September 13Amphotericin B injection
    • Shortage recently resolvedMetronidazole injection
    • 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
      • 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 continued 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).