2021 Infectious Disease Update Archive

Table of Contents

NOTE: Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal.

 

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January 2021 Infectious Disease Update

SARS-CoV-2 / COVID-19

  • 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.

Voluntary Product Recall

  • Merck has initiated a global product recall of ceftolozane-tazobactam 1.5 gm vials. Due to a recent issue identified during routine testing (sterility test results of seven batches were out of specification), product manufacturing has been temporarily stopped. Five of these batches tested positive for Ralstonia pickettii and two batches produced turbid results that could not be further identified. The seven batches were not released to the market. While all product distributed to the market has met the registered specifications for release, it was manufactured on the same equipment as the affected batches. As a result, the company has initiated a voluntary Class II (health care provider level) global recall of all ceftolozane-tazobactam within expiry.

New Product Approval

  • Ansuvimab-zykl (Ebanga), a human monoclonal antibody, for the treatment for Zaire ebolavirus (Ebolavirus) infection in adults and children. The recommended dosage is a single 50 mg/kg IV infusion. It is available in lyophilized form.

Update to CDC Treatment Guidelines for Gonococcal Infection

  • For treatment of uncomplicated urogenital, rectal, or pharyngeal gonorrhea, CDC now recommends a single 500 mg IM dose of ceftriaxone. For persons weighing ≥150 kg (300 lbs), a single 1 gm IM dose of ceftriaxone should be administered. If chlamydial infection has not been excluded, doxycycline 100 mg orally twice a day for 7 days (not azithromycin) is recommended (MMWR Morb Mortal Wkly Rep 2020;69:1911). The full update, which includes other changes such as ceftriaxone dosing for pharyngeal gonorrhea and cefixime dosing (alternative regimen), is available at PMC.

Other New or Updated Treatment Guidelines

  • Updated recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the US, from the HHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission. The recommendations are available here.
  • Guidelines for diagnosis and management of intraabdominal infection, from the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons (Clin Infect Dis 2020;71(suppl 4):S337).
  • Updated guidelines for therapeutic drug monitoring of vancomycin, from the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society (Clin Infect Dis 2020;71(suppl 4):S363). The guidelines were last updated in 2015.
  • Southern African guidelines on the safe, easy, and effective use of pre-exposure prophylaxis to prevent HIV acquisition (South Afr J HIV Med 2020;21:1152). The guidelines were last updated in 2016 and are available at PMC.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of January 3, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since December 27, 2020Posaconazole injection
    • Shortage recently resolvedDoxycycline injection, Metronidazole injection, Pentamidine isethionate
    • 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: Amphotericin B injection, Clotrimazole 10 mg oral troches, Fluconazole 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).
  • For more detailed information including estimated resupply dates, see https://www.ashp.org/Drug-Shortages/

February 2021 Infectious Disease Update

SARS-CoV-2 / COVID-19

  • 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).

March 2021 Infectious Disease Update

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).

April 2021 Infectious Disease Update

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.

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.
  • 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).

May 2021 Infectious Disease Update

2021 Sanford Guides Available

  • 2021 editions of The Sanford Guide to Antimicrobial Therapy are now available for immediate shipping from the Sanford Guide Store. This year’s books include a 1-month trial of our digital editions.

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: Updated interim public health recommendations for fully vaccinated people here.
  • Currently authorized vaccines. See COVID-19 Prevention for table summarizing use and data.
  • May 10: the US FDA expanded the EUA for the Pfizer-BioNTech COVID-19 vaccine to include adolescents 12 through 15 years of age. Full FDA news release here.
  • 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 2020;370:m3379). Available here.
  • 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 Mar 10 [Epub ahead of print]). Available at PMC.

New or Updated Treatment Guidelines

  • 2021 clinical guidelines for the diagnosis and treatment of botulism (MMWR Recomm Rep 2021;70(2):1-30). The guidelines are available here.
  • Clinical practice guidelines for nucleic acid-based testing for noninfluenza viral pathogens in adults with suspected community-acquired pneumonia, from the  American Thoracic Society (Am J Respir Crit Care Med 2021;203:1070). The guidelines are available here.
  • 2020 updated guidelines for primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors, from the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (Ann Hematol 2021 Apr 13 [online ahead of print]). The guidelines were last updated in 2013. Available here.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of May 9, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since April 11, 2021None
    • Shortage recently resolvedCefoxitin injection, Ethambutol tablets, Tobramycin lyophilized powder for injection
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Gentamicin 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, 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
      • 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 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).

June 2021 Infectious Disease Update

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.
  • 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.
  • May 26: FDA EUA for sotrovimab. Healthcare providers fact sheet here.
  • Living WHO guideline on drugs for COVID-19 (BMJ 2020;370:m3379). Available here.
  • 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 Mar 10 [Epub ahead of print]). Available at PMC.

New Product Approvals

  • Ibrexafungerp* (Brexafemme) for the treatment of adult and post-menarchal pediatric females with vulvovaginal candidiasis. Ibrexafungerp is the first triterpenoid antifungal to be approved by the US FDA. The recommended dosage is two doses of 300 mg (two 150 mg tablets) administered approximately 12 hours apart, with or without food. Verify pregnancy status in females of reproductive potential prior to initiating treatment.
  • Brincidofovir (Tembexa) for the treatment of human smallpox disease caused by variola virus in adult and pediatric patients, including neonates. Because smallpox is eradicated, the effectiveness of brincidofovir was studied in animals infected with viruses that are closely related to the variola virus. Safety information was derived from clinical trials of the drug for a non-smallpox use. The recommended dosage for adults ≥48 kg is 200 mg (tablets or oral suspension) once weekly for two doses (tablets on an empty stomach or with a low-fat meal, suspension on an empty stomach).

New or Updated Treatment Guidelines

A Brief Review of a New Type of Antifungal

  • Ibrexafungerp* is the first triterpenoid antifungal to be approved by the US FDA. It works by inhibiting the biosynthesis of β-(1,3)-D-glucan, a key component of the fungal cell wall. This mechanism of action is like that of an echinocandin, so (not surprisingly) ibrexafungerp is fungicidal against multiple Candida species and fungistatic against Aspergillus. However, ibrexafungerp and echinocandins do not share the same binding site on the target enzyme (β-(1,3)-D-glucan synthase), so limited cross-resistance is expected. A unique feature of ibrexafungerp is its oral bioavailability. It is highly protein bound, its distribution volume is large, and tissue distribution is generally good (although not the CNS). Activity seems enhanced at low pH. Serum half-life is prolonged (about 20 hours), and elimination is mainly via feces and bile. Ibrexafungerp is a CYP3A4 substrate, so moderate to strong inducers and inhibitors will affect its serum concentration. It also inhibits certain CYP enzymes and transporters, but the short duration of treatment should limit clinical significance. The drug is generally well tolerated, although it is contraindicated in pregnancy because of fetal harm observed in animal studies. Ibrexafungerp is approved for the treatment of vulvovaginal candidiasis at a dose of 300 mg q12h x2 doses, with or without food. Commercial launch in the US is expected sometime this year (J Fungi 2021;7:163).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of June 8, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since May 9, 2021Neomycin tablets
    • Shortage recently resolvedAzithromycin injection, Rifampin injection, YF-VAX
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Gentamicin 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, 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: Acyclovir injection, 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).

July 2021 Infectious Disease Update

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).

August 2021 Infectious Disease Update

SARS-CoV-2 / COVID-19

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

  • Important Note August 2021 re Delta Variant:
    • Other than hypertransmissibility and high peak viral loads, current understanding of SARS-CoV-2 infection with the currently predominant Delta variant, is very limited although improving daily. Delta has many unique properties. Most knowledge of clinical, epidemiologic, therapeutic, and diagnostic aspects of infection and COVID-19 are based on studies done in the pre-Delta era and recommendations based on references that pre-date Delta should be interpreted in that context. Of course, we will continue to update COVID-19 information and recommendations based on new developments.
  • July 28: The US FDA revises the EUA to authorize baricitinib alone for the treatment of COVID-19 in hospitalized adults and pediatric patients two years of age or older requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or ECMO. Under the revised EUA, baricitinib is no longer required to be administered with remdesivir. Fact sheet here.
  • July 28: The US FDA revises the EUA for Casirivimab + Imdevimab authorizing it for emergency use as post-exposure prophylaxis for COVID-19 in adults and pediatric individuals (12 years of age and older weighing at least 40 kg) who are at high risk for progression to severe COVID-19, including hospitalization or death. It remains authorized for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Fact sheet here.
  • 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.

US FDA New Product Approval

  • FexinidazoleTablets for the treatment of both the first-stage (hemolymphatic) and second-stage (meningoencephalitic) human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense in patients 6 years of age and older and weighing at least 20 kg. Recommended dosage (patients ≥35 kg): 1800 mg once daily x4 days, then 1200 mg once daily x6 days (with food). Product availability: 600 mg tablets.

US FDA Expanded Approvals

  • Secnidazole* (Solosec) for the treatment of trichomoniasis caused by T. vaginalis in adults. The recommended dosage is a single 2 gram packet of granules taken once orally, with or without food. Sexual partners of infected patients should be treated simultaneously. Secnidazole was initially approved in 2017 for bacterial vaginosis (BV) in adult women. Dosage for both indications is the same.
  • Zoster Vaccine Recombinant, Adjuvanted (Shingrix) for the prevention of shingles (herpes zoster) in adults aged 18 years of age or older who are or who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. It was initially approved in 2017 for the prevention of shingles in adults 50 years of age or older, in whom it is administered in two intramuscular doses 2-6 months apart. However, for adults who are or will be immunodeficient or immunosuppressed due to known disease or therapy and who would benefit from a shorter vaccination schedule, the second dose can be administered 1 to 2 months after the first dose.

From CDC

New or Updated Clinical Practice Guidelines

  • Diagnosis and management of acute hematogenous osteomyelitis in pediatrics, from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (J Pediatric Infect Dis Soc 2021 Aug 5 [online ahead of print]). The guideline is available here.
  • Immunizations in patients with inflammatory bowel disease (part 1: live vaccines), from the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association (Gastroenterology 2021;161:669). The guideline is available here.
  • Immunizations in patients with inflammatory bowel disease (part 2: inactivated vaccines), from the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association (Gastroenterology 2021;161:669). The guideline is available here.
  • Danish national guidelines for the treatment of adult patients with Clostridioides difficile infection and the use of fecal microbiota transplantation (Scand J Gastroenterol 2021 July 14 [online ahead of print]). Available here.
  • Clinical practice guidelines for the treatment of Helicobacter pylori infection in Korea 2020 (Korean J Intern Med 2021;36:807). The guidelines were last updated in 2013. Available here.
  • Updated WHO guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; 2021. These guidelines update the 2003 publication. Available here.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of August 10, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since July 13, 2021None
    • Shortage recently resolvedCeftazidime-avibactam injection, Cidofovir injection, Chloroquine tablets
    • Antibacterial and antimycobacterial 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, 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, 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
    • 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).

September 2021 Infectious Disease Update

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.
  • 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.

First COVID-19 Vaccine Approval

  • The Pfizer-BioNTech COVID-19 mRNA vaccine (Comirnaty (koe-mir’-na-tee)), for the prevention of COVID-19 disease in persons 16 years of age and older. The vaccine also continues to be available under EUA for individuals 12-15 years of age and for the administration of a third dose in certain immunocompromised persons. Vaccination schedule: 2 doses (0.3 mL each) administered intramuscularly, 3 weeks apart.

From CDC

  • 2021-22 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2021;70;1-28). Available here.

New or Updated Practice Guidelines

  • European Crohn’s and Colitis Organization (ECCO) guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease (J Crohns Colitis 2021;15:879). The last update was in 2014. Available here.
  • Japanese clinical practice guidelines for management of sepsis and septic shock 2020 (J-SSCG 2020) (J Intensive Care 2021;9:53). These guidelines, revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, were first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. Available here.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of September 2, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since August 10, 2021Dicloxacillin capsules, Tocilizumab injection
    • Shortage recently resolvedCeftazidime-avibactam injection, Cidofovir injection, Chloroquine tablets
    • Antibacterial and antimycobacterial 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, 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, 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
    • 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).

October 2021 Infectious Disease Update

SARS-CoV-2 / COVID-19

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

  • September 16: The US FDA revises the EUA for Bamlanivimab + Etesevimab authorizing the combination for emergency use as post-exposure prophylaxis for COVID-19 in adults and pediatric individuals (12 years of age and older weighing at least 40 kg) who are at high risk for progression to severe COVID-19, including hospitalization or death. It remains authorized for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Fact sheet here.
  • 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 Practice Guidelines

Preventing Influenza in Children

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of October 12, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since September 7, 2021Gentamicin sulfate 3% ophthalmic ointment
    • Shortage recently resolvedCeftazidime-avibactam injection, Cidofovir injection, Chloroquine tablets
    • Antibacterial and antimycobacterial 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 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).

November 2021 Infectious Disease Update

SARS-CoV-2 / COVID-19

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).

December 2021 Infectious Disease Update

SARS-CoV-2 / COVID-19

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

  • December 9: The US FDA amends the Pfizer-BioNTech COVID-19 vaccine EUA to authorize the use of a single booster dose to individuals 16 and 17 years of age at least six months after completion of primary vaccination with the Pfizer-BioNTech vaccine.
  • December 8: The US FDA issues an EUA for tixagevimab co-packaged with cilgavimab and administered together for the pre-exposure prophylaxis of COVID-19 in certain adults and pediatric individuals (≥12 years of age weighing ≥40 kg). Authorization is only for individuals who are not currently infected with SARS-CoV-2 and who have not recently been exposed to an infected individual. The EUA also requires that individuals either have a moderate to severely compromised immune system or a history of severe adverse reaction to vaccination.
  • December 3: The US FDA amends the EUA of bamlanivimab and etesevimab (previously authorized for pediatric patients ≥12 years of age weighing ≥40 kg), authorizing the combination for the treatment of mild to moderate COVID-19 in all younger pediatric patients, including newborns, who have a positive COVID-19 test and are at high risk for progression to severe COVID-19, including hospitalization or death. This revision also authorizes the combination for post-exposure prophylaxis for prevention of COVID-19 in all pediatric patients, including newborns, at high risk of progression to severe COVID-19, including hospitalization or death. Fact sheet here.
  • November 23: The US FDA amends the EUA for both the Moderna and Pfizer-BioNTech COVID-19 vaccines authorizing use of a single booster dose for all individuals 18 years of age and older after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine.
  • November 4: The Medicines and Healthcare products Regulatory Agency (MHRA) in the UK authorizes the use of the orally administered drug molnupiravir (Lagevrio) for use in people who have mild to moderate COVID-19 and at least one risk factor for developing severe illness. Such risk factors include obesity, older age (>60 years), diabetes mellitus, or heart disease. The authorized dose is 800 mg (four 200 mg capsules) every 12 hours for 5 days.
  • CDC: Interim public health recommendations for fully vaccinated people here.
  • COVID-19 vaccination in cancer patients: preliminary recommendations from NCCN here.
  • Currently authorized vaccines. See COVID-19 Prevention for table summarizing use and data.
  • ESCMID COVID-19 living guidelines: drug treatment and clinical management (Clin Microbiol Infect 2021 Nov 22 [online ahead of print]). Available at PMC.
  • 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;375:n2936).
  • 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.
  • Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: therapy section (J Infect Public Health 2021 Oct 20 [online ahead of print]). Last updated in 2020. Available at PMC.

US FDA New Product Approval

  • Maribavir* for the treatment of adults and pediatric patients (≥12 years of age, weight ≥35 kg) with post-transplant cytomegalovirus (CMV) infection/disease that is refractory to treatment (with or without genotypic resistance) with ganciclovir, valganciclovir, cidofovir or foscarnet. Maribavir inhibits human CMV-encoded kinase pUL97, an important enzyme in viral replication. HCMV pUL97 is also responsible for the activation of ganciclovir. Recommended dosage: 400 mg (two 200 mg tablets) po twice daily, with or without food.

New or Updated Practice Guidelines

  • Executive summary. Guidelines for chlamydial urethritis, from the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (J Infect Chemother 2021 Dec 6 [online ahead of print]).
  • Joint Healthcare Infection Society (JIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities (J Hosp Infect 2021;118S:S1).
  • Prevention, diagnosis, and management of post-surgical mediastinitis in adults: consensus guidelines of the Spanish Society of Cardiovascular Infections, the Spanish Society of Thoracic and Cardiovascular Surgery, and the Biomedical Research Centre Network for Respiratory Diseases (J Clin Med 2021;10(23):5566). Available at PMC.
  • Clinical practice guidelines for the prevention and management of tick-borne illness in the United States, from the Wilderness Medical Society (Wilderness Environ Med 2021 Oct 9 [online ahead of print]). PDF available here.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of December 13, 2021) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since November 8, 2021:
      • Amphotericin B injection
      • Doxycycline oral suspension
      • Rifapentine tablets
    • Shortage recently resolved:
      • Cefotetan injection
    • 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),
        • 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
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules
        • Piperacillin-tazobactam injection
      • 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], June 2020)
    • Bacitracin injection (February 2020)
    • Interferon alfa-2b (Intron A, October 2019)
    • Mupirocin calcium 2% nasal ointment (Bactroban Nasal [GSK], August 2019)