August 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.
 

AUGUST 2022

 

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 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 2022;28:222). 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.

From CDC

  • Interim guidance for prevention and treatment of monkeypox in persons with HIV infection (MMWR Morb Mortal Wkly Rep 2022 Aug 5 [Epub ahead of print]). PDF available here.
  • Interim recommendation from ACIP for use of the Novavax vaccine in persons aged ≥18 years as a primary 2-dose series vaccination for the prevention of COVID-19 (MMWR Morb Mortal Wkly Rep 2022;71:988–992). PDF available here.

Reduced Susceptibility of C. difficile to Vancomycin

  • Clostridioides difficile isolates exhibiting reduced susceptibility to vancomycin are described in two distinct geographic locations on different continents (Houston, Texas and Nairobi, Kenya). To identify stool samples containing nonsusceptible C. difficile isolates, samples were plated on C. difficile culture medium (CDPA) only and CDPA containing either vancomycin 4 μg/mL or metronidazole 8 μg/mL (based on CLSI breakpoint concentrations). Of the Houston stool samples (obtained from patients with CDI), 114/438 (26%) contained vancomycin nonsusceptible C. difficile isolates. 66/98 (67%) of the stool samples from Nairobi patients harbored vancomycin nonsusceptible isolates. 29% and 85% of the isolates from Houston and Nairobi were metronidazole nonsusceptible, respectively. In a CDI mouse model infected with a vancomycin nonsusceptible isolate, vancomycin failed to eradicate the infection. Whole-genome sequencing analyses did not identify vanA genes, suggesting an alternate mechanism of resistance. The potential spread of vancomycin nonsusceptible C. difficile has serious public health implications (Clin Infect Dis 2022;74:120).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of August 7, 2022) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since July 11, 2022:
      • Amphotericin B Lipid Complex (not liposomal), Penicillin G sodium 5 million units/vial (10 count)
    • Shortage recently resolved:
      • Amphotericin B injection, Tocilizumab injection
    • 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
        • Cefixime capsules
        • 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
        • Cefuroxime injection
      • Clindamycin injection
      • Doxycycline oral suspension
      • Fluoroquinolones:
        • Ciprofloxacin 0.3% ophthalmic solution
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1% (unavailable)
        • Erythromycin 0.5% ophthalmic ointment
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Piperacillin-tazobactam injection
      • Quinupristin-Dalfopristin injection
      • Topical (miscellaneous) antibacterials:
        • Bacitracin ophthalmic ointment
        • Neomycin and Polymyxin B sulfates GU irrigant
        • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
        • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs in continued reduced supply
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs in continued reduced supply
      • Rifampin capsules
      • Rifampin injection
      • Rifapentine tablets
    • Antiviral drugs in continued reduced supply
      • None
    • Vaccines in continued reduced supply:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Gemifloxacin 320 mg tablet (August 2022, no further US distribution)
    • Gentamicin sulfate 0.3% ophthalmic ointment (July 2022)
    • 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)