December 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.

December 2020

Sanford Guide Announcements

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
    • FDA authorizes emergency use of Pfizer-BioNTech COVID-19 Vaccine on 11 Dec 2020. See COVID-19 Prevention for summary of FDA Provider Fact Sheet / Emergency Prescribing Information.
    • 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). The first version of this living guidance focuses on corticosteroids. Available on the BMJ website.
  • Guidelines on COVID-19 management in cancer patients, from the Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology (Eur J Cancer 2020;140:86). The guidelines are available at PMC.
  • Casirivimab + Imdevimab (administered together). FDA EUA (11/21/20) for treatment of mild to moderate COVID-19 in adults and children (age ≥12 years, wt ≥40 kg) who are at risk of progression to severe disease and/or hospitalization.

Baloxavir Updates

  • In addition to its indication for treatment of acute uncomplicated influenza, baloxavir marboxil is now indicated for post-exposure prophylaxis of influenza in persons 12 years of age and older following contact with an infected person. The dosing is the same as for treatment of acute infection.
  • Also new is a granule form for oral suspension, intended for patients who are unable to swallow tablets. One bottle contains 40 mg of baloxavir marboxil (after reconstitution with 20 mL of water) and must be used within 10 hours.

New or Updated Treatment Guidelines

Practice Pearls from the Recent Literature

  • A pharmacokinetic drug interaction between hydromorphone and rifampin might be unexpected, given the minor role of the CYP450 system in hydromorphone metabolism. In a randomized crossover study of 12 subjects, rifampin reduced the AUC of oral and intravenous hydromorphone by 43% and 26%, respectively. This is similar to the magnitude of the interaction between morphine and rifampin, and may be due to induction of UGT (glucuronidation) enzymes by rifampin (Anesth Analg 2020 Nov 6 [Epub ahead of print]).
  • Appropriate dosing of linezolid in obesity is uncertain. In a prospective pharmacokinetic study in critically ill obese patients (median total body weight 140 kg) with severe skin and soft tissue infections, the probability of PK/PD target attainment with standard dosing  (600 mg q12h) failed to reach ≥90% for organisms with MICs ≥2 µg/mL. These data add to a growing body of evidence that standard dosing of linezolid in obesity may be inadequate (Antimicrob Agents Chemother 2020 Nov 30 [Epub ahead of print]).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of December 13, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since November 10None
    • Shortage recently resolvedMetronidazole 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
      • 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: Doxycycline injection
      • 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).