April 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.

April 2021

2021 Sanford Guides Available for Preorder

  • 2021 editions of The Sanford Guide to Antimicrobial Therapy are now available for preorder from the Sanford Guide Store. We expect to begin shipping in the next few weeks. This year’s books include a 1-month trial of our digital editions.


  • 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.
  • 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.
  • A living WHO guideline on drugs to prevent COVID-19 (BMJ 2021;372:n526). Available here.
  • Management of hospitalized adults with COVID-19: a European Respiratory Society living guideline (Eur Respir J 2021 Mar 10 [Epub ahead of print]). Available at PMC.

CDC Health Alert Network

  • HAN #442 (Health Alert): The US CDC and FDA are reviewing data involving six US cases of cerebral venous sinus thrombosis in combination with thrombocytopenia in individuals who received the Johnson & Johnson (Janssen) COVID-19 vaccine. As of April 12, 2021, approximately 6.85 million doses of the J&J COVID-19 vaccine have been administered in the US. All six cases occurred among women aged 18–48 years. The interval from vaccine receipt to symptom onset ranged from 6–13 days. One patient died. Until the review is complete, CDC and FDA are recommending a pause in the use of the J&J COVID-19 vaccine out of an abundance of caution. Click here for the full Health Alert.

New Product Approval

  • Oritavancin (Kimyrsa) for the treatment of adult patients with acute bacterial skin and skin structure infections caused by susceptible gram-positive microbes, including MRSA. This is the same indication as Orbactiv, the initial formulation of oritavancin to be FDA approved. The key difference of the new formulation is a one hour duration of infusion, rather than three hours. It also is supplied in different dose strengths and has different preparation instructions, including differences in reconstitution, dilution, and compatible diluents. Recommended dosage: 1200 mg IV over one hour as a single dose. A summer launch of the product is planned.

New or Updated Treatment Guidelines

Return of YF-VAX

  • Sanofi Pasteur has announced that yellow fever vaccine YF-VAX is once again available for purchase in the United States. They expect to begin allowing orders through www.VaccineShoppe.com and www.VaxServe.com the week of April 5th. For more information, click here.

Commercial Availability of Artesunate for Injection

  • Injectable Artesunate* for treatment of severe malaria is now commercially available in the US. There may be a delay before drug is stocked in pharmacies and hospitals. CDC will continue to distribute artesunate under its IND protocol in situations where the FDA-approved product is not yet available within 24 hours of a clinician requesting the drug. For more information, click here.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of April 11, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since March 8, 2021None
    • Shortage recently resolvedPosaconazole injection
    • 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), 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, Rifampin injection
    • Antifungal, antiparasitic, and antiviral drugs in continued reduced supply:
      • Antifungal drugs: 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 scheduled for re-launch in the US during  the week of April 5).
  • 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).