November 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.

November 2021


Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.

  • October 29: The US FDA authorizes the emergency use of the Pfizer-BioNTech vaccine for the prevention of COVID-19 to include children 5 through 11 years of age. It is administered as a two-dose primary series, 3 weeks apart, but at a lower dose (10 µg/0.2 mL IM) than that used for individuals ≥12 years of age (30 µg/0.3 mL IM).
  • October 20: The US FDA revises the EUAs for COVID-19 vaccines to allow for the use of a single booster dose as follows:
    • The use of a single booster dose of the Moderna vaccine (50 µg/0.25 mL IM, which is half of the dose given for a primary series dose) administered at least 6 months after completion of the primary series to individuals:
      • ≥65 years of age.
      • 18 through 64 years of age at high risk of severe COVID-19.
      • 18 through 64 years of age with frequent institutional or occupational exposure to SARS-CoV-2.
    • The use of a single booster dose of the Janssen (Johnson and Johnson) vaccine (0.5 mL IM, which is the same dose as the first dose) may be administered at least 2 months after completion of the single-dose primary regimen to individuals 18 years of age and older.
    • The use of each of the available vaccines as a heterologous (“mix and match”) booster dose in eligible individuals following completion of primary vaccination with a different vaccine.
  • September 22: The US FDA revises the EUA for the Pfizer-BioNTech vaccine to allow for use of a single booster dose (30 µg/0.3 mL IM, which is the same dose as a primary series dose) to be administered at least six months after completion of the primary series to individuals:
    • ≥65 years of age.
    • 18 through 64 years of age at high risk of severe COVID-19.
    • 18 through 64 years of age with frequent institutional or occupational exposure to SARS-CoV-2.
  • 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.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of October 29, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since October 12, 2021Artesunate injection (if unable to secure an emergency shipment via usual distribution channels, contact CDC (770) 488-7788, or after hours (770) 488-7100), Metronidazole injection
    • Shortage recently resolvedCeftazidime-avibactam injection, Cidofovir injection, Chloroquine tablets
    • Antibacterial and antimycobacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Gentamicin injection, Gentamicin sulfate 3% ophthalmic ointment, 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 Provepharm Life Solutions and its distributor Direct Success. Click here for details), Cefotetan injection, Ceftazidime injection, Ceftolozane-tazobactam injection
      • Clindamycin injection
      • Ethambutol tablets
      • 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, Dicloxacillin capsules, Piperacillin-tazobactam injection
      • Tetracyclines: None
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, 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
      • Clotrimazole 10 mg oral troches
      • Hydroxychloroquine tablets
      • Tocilizumab 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).