March 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.

March 2021

 

SARS-CoV-2 / COVID-19

  • Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.
  • CDC: Interim public health recommendations for fully vaccinated people here.
  • Janssen (J&J) vaccineFDA EUA on 27 Feb 2021. Fact sheet for healthcare providers here.
  • Currently authorized vaccines. See COVID-19 Prevention for table summarizing use and data.
  • COVID-19 vaccination in cancer patients: preliminary recommendations from NCCN here.
  • 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 here.
  • Bamlanivimab + Etesevimab combination monoclonal antibody therapy for mild-moderate COVID-19. FDA EUA on 9 Feb 2021.
  • NEW: a living WHO guideline on drugs to prevent COVID-19 (BMJ 2021;372:n526). Available here.

CDC Health Alert Network

  • HAN #439 (Health Advisory): CDC is providing information on extensively drug-resistant (XDR) Salmonella Typhi (Typhi) infections among US residents without international travel, and treatment recommendations for XDR Typhi infection. Click here for the full health advisory.

2021 CDC Immunization Schedules

  • Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2021 (MMWR Morb Mortal Wkly Rep 2021;70:189). Immunization schedules are available here.
  • Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2021 (MMWR Morb Mortal Wkly Rep 2021;70:193). Immunization schedules are available here.

New or Updated Treatment Guidelines

  • Summary of the recently published WHO/PAHO guidelines for diagnosing and managing disseminated histoplasmosis in people living with HIV (J Fungi [Basel] 2021;7:134); available at PMC. Full guidelines available here.
  • Updated (2020) guidelines for the treatment of complicated skin and soft tissue infections, from the Surgical Infection Society (Surg Infect [Larchmt] 2021 Feb 26 [Epub ahead of print]). This is an update of the guidelines published in 2009.

Azole Dosing in Hepatic Impairment

  • Two recent publications fill a few gaps in our knowledge of azole dosing in hepatic impairment. For isavuconazonium*, we know that no dosage adjustment is required in patients with mild to moderate impairment (Child-Pugh Class A and B), but no recommendations for severe impairment (Child-Pugh Class C) have been possible. However, recent pharmacokinetic data support a 50% dosage reduction in severe (Child-Pugh Class C) impairment (Antimicrob Agents Chemother 2021 Feb 22 [Epub ahead of print]).
  • For voriconazole*, the manufacturer recommends that in patients with mild to moderate impairment, the standard loading dose is appropriate, but the maintenance dose should be halved. No recommendations for patients with severe impairment are provided. However, a pharmacokinetic study suggests that these recommendations may result in supratherapeutic concentrations. Study data indicate that a halved loading dose regimen be considered in cirrhotic patients, with a maintenance dose of 33% of the non-cirrhotic dose in patients with mild to moderate impairment, and 25% of the non-cirrhotic dose in patients with severe impairment (Pharmacotherapy 2021;41:172).

Quick Drug Interaction Reminder

  • Ritonavir-boosted antiretroviral (ARV) regimens are associated with an increased risk of drug-drug interactions, with potentially serious outcomes. A patient stable on boosted fosamprenavir plus emtricitabine/tenofovir for ten years experienced significant hyperkalemia after beginning treatment with eplerenone, a mineralocorticoid receptor antagonist, for left ventricular dysfunction. ARVs and eplerenone were held, and the potassium normalized. Subsequent use of a dolutegravir-based regimen allowed for reinstitution of eplerenone with no recurrence of hyperkalemia. Eplerenone is a CYP3A4 substrate, fosamprenavir and ritonavir are potent inhibitors of CYP3A4, and dolutegravir does not inhibit CYP enzymes (Int J STD AIDS 2021 Feb 25 [Epub ahead of print]).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of March 8, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since February 9, 2021Gentamicin injection, Rifampin injection
    • Shortage recently resolvedAmphotericin B injection, Fluconazole 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, 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: Clotrimazole 10 mg oral troches, Posaconazole injection
      • 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).