February 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 sign up for ID updates to your inbox, register here.

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. If you received this message from a colleague, subscribe now.

February 2021



  • Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.
  • COVID-19 Vaccine (Emergency Use Authorization). See COVID-19 Prevention for summary of FDA Provider Fact Sheet / Emergency Prescribing Information for each.
    • Pfizer-BioNTech COVID-19 Vaccine on 11 Dec 2020 (US FDA).
    • Moderna COVID-19 Vaccine on 18 Dec 2020 (US FDA).
    • Oxford AstraZeneca COVID-19 Vaccine on 30 Dec 2020 (UK)
  • Vaccine development pipeline: see COVID-19, Prevention for summary of other vaccine development and clinical trials.
  • 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). Available on the BMJ website.
  • Surviving Sepsis Campaign guidelines on the management of adults with COVID-19 in the ICU: first update (Crit Care Med 2021 Jan 28 [Epub ahead of print]). Available on the journal website.

New Product Approvals

  • Cabotegravir injectable and rilpivirine injectable (Cabenuva), a two-drug co-packaged product, indicated to replace the current antiretroviral regimen in adult patients with HIV-1 infection who are virologically suppressed (RNA <50 copies/mL) on a stable regimen with no history of treatment failure and no known or suspected resistance to either component. Lead-in dosing with oral cabotegravir and oral rilpivirine should be used for one month before initiation of injectable dosing to assess tolerance. Recommended dosing schedule: Cabotegravir/rilpivirine 600 mg/900 mg IM on the last day of oral lead-in, then 400 mg/600 mg IM every month thereafter.
  • Cabotegravir tablets (Vocabria) for use (in combination with oral rilpivirine) as oral lead-in therapy to assess tolerability prior to administration of the injectable forms, and as oral therapy for patients who will miss planned injection dosing. Lead-in dosing is cabotegravir 30 mg (+ rilpivirine 25 mg) once daily for one month. If a patient plans to miss a scheduled injection by more than seven days, daily oral therapy with cabotegravir 30 mg plus rilpivirine 25 mg is taken to replace up to two consecutive monthly injections. The first dose of oral therapy should be taken approximately one month after the last injections and continued until the day injection dosing is resumed. Product availability: 30 mg tablets.

New or Updated Treatment Guidelines

  • Updated evidence-based treatment guidelines for MRSA from the UK (JAC-Antimicrobial Resistance 2021;3:dlaa114). The guidelines were last updated in 2008 and are available on the journal website.
  • Evidence-based guidelines for the treatment of Helicobacter pylori infection in Korea in 2020 (Gut Liver 2021 Jan 20 [Epub ahead of print]). Available on the journal website.
  • Chinese clinical practice guidelines for the prevention of mother-to-child transmission of hepatitis B virus, launched by the Society of infectious Diseases, Chinese Medical Association (J Clin Transl Hepatol 2020;8:397). Available at PMC.
  • Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (Ann Hematol 2021;100:321). Available at PMC.
  • Clinical practice guidelines for adult appendicitis, from the French Society of Digestive Surgery and the Society of Abdominal and Digestive Imaging (J Visc Surg 2021 Jan 5 [Epub ahead of print]).
  • Executive summary of the JSMM clinical practice guidelines for the diagnosis and treatment of Cryptococcosis 2019, from the Japanese Society for Medical Mycology (Med Mycol J 2020;61:61). The executive summary is available here.

A Few Drug Pearls

  • Based on a pharmacokinetic study in six critically ill hematology patients, no a priori dose adjustment of posaconazole during ECMO is recommended. Some trough concentrations were below the lower limit for treatment, however, so therapeutic drug monitoring is recommended to ensure adequate drug exposure (J Antimicrob Chemother 2021 Jan 29 [Epub ahead of print]).
  • A recent report describes the inappropriate use of IM benzylpenicillin G rather than benzathine penicillin G in one patient with syphilis (resulting in treatment failure), and the attempted use of IM benzylpenicillin G in another. Other disturbing treatment errors with long-acting penicillin G products have occurred, such as the improper use of the procaine-benzathine preparation of penicillin G (instead of benzathine) in 429 syphilis patients over a five-year period (MMWR 2005;54:217). Recent product shortages have likely increased the risk of error (Sex Transm Infect 2020;96:552).
  • The effects of ECMO on vancomycin pharmacokinetic parameters are conflicting and poorly understood. Changes may be minimal, and no standard dosage adjustment seems reasonable. However, aggressive therapeutic drug monitoring is recommended to achieve efficacy and safety targets. Continuous infusion may lessen PK changes. References: Antimicrob Agents Chemother 2021;65:e02408-20J Clin Pharm Ther 2020;45:1066Clin Pharmacokinet 2020;59:1575.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of February 9, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since January 13, 2021Posaconazole injection
    • Shortage recently resolvedFluconazole injection, Tobramycin lyophilized powder for injection
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Tobramycin 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, Ceftolozane/tazobactam 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: None
      • 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: Amphotericin B injection, Clotrimazole 10 mg oral troches
      • Antiparasitic drugs: Chloroquine tablets, Hydroxychloroquine tablets
      • 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).