Oct '22 Infectious Disease Update

Oct 11th 2022

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board and Antimicrobial Stewardship Program Manager. 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.

OCTOBER 2022

Sanford Guide on the Road

Our team will be in attendance at SIDP, IDWeek, and HealthConnect Pharmacy in the coming weeks. Drop by our booth for special offers and to learn about what's new with Sanford Guide!

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.

Antimicrobial Stewardship Pearl

A recent consensus statement from the Society for Healthcare Epidemiology of America provides recommendations for hospitals and healthcare personnel to improve antimicrobial stewardship and antibiotic use during infectious disease public health emergencies such as outbreaks, epidemics, and pandemics. The statement encourages leveraging the expertise of Antimicrobial Stewardship Programs to limit inappropriate antibiotic prescribing practices by facilitating evidence-based care.

From ACIP

This report summarizes all recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP) for the use of lyophilized CVD 103-HgR vaccine (Vaxchora) in the US. CVD 103-HgR, a single-dose, live attenuated oral cholera vaccine derived from V. cholerae O1, is the only cholera vaccine licensed for use in the US (MMWR Recomm Rep 2022;71:1-8). PDF available here.
Updated recommendations for the use of 15-valent pneumococcal conjugate vaccine (PCV15, Vaxneuvance) in US children (MMWR Morb Mortal Wkly Rep 2022;71:1174). PDF available here.

Pentavalent Antimonials for Leishmaniasis

Stibogluconate sodium (Pentostam) has been discontinued by GSK worldwide and is no longer available from CDC.
Meglumine antimoniate (Glucantime) is available from Sanofi after obtaining an IND from FDA. Click here for instructions.

CDC Discontinues Distribution of Artesunate

CDC has discontinued distribution of intravenous artesunate for treatment of severe malaria in the US. Commercial IV artesunate is available in adequate supply from major drug distributors. Click here for more details.

ZeNix Trial for Highly Drug-Resistant Tuberculosis

The six-month oral regimen of bedaquiline-pretomanid-linezolid has 90% efficacy against highly drug-resistant tuberculosis. Unfortunately, peripheral neuropathy and myelosuppression associated wtih linezolid (1200 mg po once daily) in this regimen are problematic. In the ZeNix trial, different doses and durations of linezolid were investigated for efficacy and safety. The regimen employing linezolid 600 mg once daily for 26 weeks appeared to have the most favorable risk-benefit profile (N Engl J Med 2022;387:810).

ART in Pregnancy

A dolutegravir (DTG)-based regimen is preferred as first-line antiretroviral therapy (ART) in pregnant persons infected with HIV. However, safety and efficacy data for other INSTI-based, PI-based, and NNRTI-based regimens compared to DTG-based ART are lacking. In this US multisite cohort study, DTG-based ART was superior to regimens based on atazanavir/r, raltegravir, and elvitegravir/cobicistat, and similar to regimens based on darunavir/r and rilpivirine, in achieving viral suppression at delivery. No clear differences in risk of adverse birth outcomes with DTG-based ART compared to other ART regimens were observed (N Engl J Med 2022;387:799).

Ceftaroline and CNS Infection

Ceftaroline is a possible option for CNS infection due to MRSA, but supportive data are scant. In a population pharmacokinetic model, an inverse relationship was found between CSF glucose concentration and intercompartmental clearance into the CSF. Model simulations showed a median ceftaroline penetration into the CSF of 4% in the group with uninflamed meninges, 19% in the group with mildly inflamed meninges, and 62% in the group with inflamed meninges. These differences in CSF exposure result in marked differences in probability of target attainment for specific microbes. The authors suggest that a dose of 600 mg IV q8h should be further evaluated for treatment of CNS infection (Antimicrob Agents Chemother 2022;66: e0074122).

Drug Shortages (US)

Antimicrobial drugs or vaccines in reduced supply or unavailable (as of October 9, 2022) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
- New on the list since September 11, 2022:
  - None
- Shortage recently resolved:
  - Cefepime injection
  - Daptomycin injection
  - Neomycin and Polymyxin B sulfates GU irrigant
  - Rifapentine tablets
- Antibacterial and antimycobacterial drugs in continued reduced supply:
  - Aminoglycosides:
    - Amikacin injection
    - Gentamicin injection
    - Neomycin tablets
    - Tobramycin injection
  - Carbapenems:
    - Meropenem injection
  - Cephalosporins:
    - Cefazolin injection
    - Cefixime 400 mg 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
  - Rifaximin 200 mg tablets
  - Topical (miscellaneous) antibacterials:
    - Bacitracin ophthalmic ointment (unavailable)
    - Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
    - Sulfanilamide 15% vaginal cream (unavailable)
- Antifungal drugs in continued reduced supply:
  - Amphotericin B Lipid Complex (ABLC)
  - Clotrimazole 10 mg oral troches
- Antimycobacterial drugs in continued reduced supply:
  - Isoniazid 300 mg tablets
  - Rifampin capsules
  - Rifampin injection
- Antiviral drugs in continued reduced supply:
  - None
- Vaccines in continued reduced supply:
  - None

Antimicrobial drugs recently discontinued:
- Quinupristin-Dalfopristin (discontinued by Pfizer in early 2022, no other supplier)
- 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)

For more detailed information including estimated resupply dates, see https://www.ashp.org/Drug-Shortages/