July 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.

July 2021

SARS-CoV-2 / COVID-19

Sanford Guide SARS-CoV-2 / COVID-19 information is freely available to all for the course of the pandemic. Please share this message or the URL https://www.sanfordguide.com/coronavirus with any who might benefit.

  • June 24: the US FDA issues an EUA for tocilizumab for the treatment of hospitalized adults and pediatric patients (2 years of age and older) who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or ECMO. Tocilizumab is not authorized for use in outpatients with COVID-19. FDA news release here. Healthcare provider fact sheet here.
  • June 3: the US FDA issues significant updates to the EUA for casirivimab and imdevimab. These updates include a change in the authorized dosage, the addition of subcutaneous administration as an alternative route when IV infusion is not feasible, and the addition of a co-formulated product in a single vial.
  • 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.
  • Living WHO guideline on drugs for COVID-19 (BMJ 2021;374:n1703).
  • Living WHO guideline on drugs to prevent COVID-19 (BMJ 2021;372:n526). Available here.
  • Living WHO guideline on prophylaxis against COVID-19 (BMJ 2021;373:n949). Available at PMC.
  • Management of hospitalized adults with COVID-19: a European Respiratory Society living guideline (Eur Respir J 2021;57(4):2100048). Available at PMC.

New or Updated Treatment Guidelines

  • 2021 focused update guidelines from the IDSA and SHEA for management of Clostridioides difficile infection in adults (Clin Infect Dis 2021 Jun 24 [online ahead of print]). This update specifically addresses the use of fidaxomicin and bezlotoxumab for the treatment of CDI. The guidelines are available here.

New Formulations

  • Posaconazole (Noxafil PowderMix) delayed-release oral suspension, for pediatric patients 2 years of age and older (weighing 40 kg or less). The various oral formulations of posaconazole (delayed-release tablets, oral suspension, and delayed-release oral suspension) are not interchangeable. Follow the specific dosage recommendations for each formulation.
  • Glecaprevir/pibrentasvir (Mavyret) for the treatment of chronic hepatitis C virus (genotype 1-6) in adults and pediatric patients 3 years and older without cirrhosis or with compensated cirrhosis. The FDA approved an oral pellet formulation (glecaprevir 50 mg/pibrentasvir 20 mg) for use in children age 3 to <12 years old weighing <45 kg. The recommended dosage in that group is based on weight.
  • Sofosbuvir/velpatasvir (Epclusa) for the treatment of chronic hepatitis C virus in pediatric patients 3 years of age and older, regardless of HCV genotype or liver disease severity. The FDA approved two strengths of an oral pellet formulation (sofosbuvir 200 mg/velpatasvir 50 mg and sofosbuvir 150 mg/velpatasvir 37.5 mg) for use by younger children who cannot swallow tablets. The recommended dosage in children 3 years of age and older is based on weight.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of July 13, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since June 8, 2021Bacitracin ophthalmic ointment, Ethambutol tablets
    • Shortage recently resolvedAcyclovir injection
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Gentamicin injection, Neomycin tablets, 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, 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 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)
    • Antifungal, antiparasitic, and antiviral drugs in continued reduced supply:
      • Antifungal drugs: Clotrimazole 10 mg oral troches
      • Antiparasitic drugs: Chloroquine tablets, Hydroxychloroquine tablets
      • Antiviral drugs: Cidofovir injection
    • Vaccines in continued reduced supply:
      • Hepatitis B vaccine recombinant
  • Antimicrobial drugs recently discontinued: 
    • 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).