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. If you received this message from a colleague, subscribe now.
 

May 2019
 

New Print Editions Now Available

• Sanford Guide's 2019 print editions are now available for immediate shipping. New this year is a spiral-bound edition combining HIV/AIDS Therapy and Hepatitis Therapy.

New Drug Approvals

• Avaclyr (acyclovir* 3% ophthalmic ointment), approved for the treatment of acute herpetic keratitis (dendritic ulcers) in patients with HSV-1 and HSV-2. Recommended dosage: one ribbon of ointment in the lower cul-de-sac of the affected eye 5 times a day until ulcer has healed, then 3 times daily for 7 days. Product availability: 3.5 gm tubes.
• Dengvaxia (Dengue Tetravalent Vaccine, Live), approved by the US FDA for the prevention of dengue disease caused by all dengue virus serotypes (1, 2, 3, and 4). There are major restrictions: the vaccine is approved only for use in individuals age 9-16 with laboratory-confirmed previous dengue infection and living in endemic areas. It is a live, attenuated vaccine that is administered as three separate injections six months apart. The vaccine has already been approved in 19 countries and the European Union.
• Tolsura (itraconazole*), approved for the treatment of blastomycosis (pulmonary and extrapulmonary), histoplasmosis (including chronic cavitary pulmonary disease and disseminated, non-meningeal histoplasmosis), and aspergillosis (pulmonary and extrapulmonary) in patients who are intolerant of or who are refractory to amphotericin B*. This product is a new formulation with improved bioavailability. Availability: 65 mg capsules.

Updated Pediatric HIV Guidelines

• Updated Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection from the HHS Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV are available on the AIDSinfo website.

New or Updated Treatment Guidelines

• Updated guidelines for the epidemiology, diagnosis, prevention, and management of infection due to Arenaviruses and West Nile Virus (WNV) in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 25 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention and management of Human T-cell lymphotrophic virus 1 (HTLV)-1 in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 25 [Epub ahead of print]).
• Updated guidelines for the prevention and management of Clostridium difficile infection in solid organ transplant (SOT) recipients from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 19 [Epub ahead of print]).
• Updated guidelines for the vaccination of solid organ transplant candidates and recipients from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 19 [Epub ahead of print]).

Practice Pearls

• Eculizumab is a monoclonal antibody that binds to complement protein C5, inhibiting its cleavage to C5a and C5b and thereby inhibiting deployment of the terminal complement system. It is indicated for paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome, and anti-acetylcholine receptor antibody-positive generalized myasthenia gravis. Unfortunately, complement blockade at C5 interferes with the immune system’s ability to respond effectively to Neisseria infection. Therapy with eculizumab is thought to increase the risk of meningococcal disease 1000- to 2000-fold. The product labeling includes a black box warning about life-threatening and fatal infection due to N. meningitidis*, but infection due to other Neisseria species is less well characterized. The first case series of N. gonorrhoeae* infections in patients receiving eculizumab was recently published. Eight of nine cases of N. gonorrhoeae infection identified by an FDA spontaneous safety report search were disseminated gonococcal infection (DGI). All eight DGI patients were hospitalized, seven were bacteremic, and two required pressor support (one of whom also required mechanical ventilation). The limited data suggest that patients treated with eculizumab may be at higher risk of DGI than the general population (Clin Infect Dis 2018 Nov 12 [Epub ahead of print]).

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of May 4, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since April 21]: Doxycycline injection
  • [Shortage recently resolved]: Ciprofloxacin injection
  • [Continue to be in reduced supply]:
    • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
    • Carbapenems: Meropenem injection
    • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable), Erythromycin 0.5% ophthalmic ointment
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
    • Antifungal drugs: Amphotericin B injection (unavailable), Clotrimazole 10 mg oral troches, Fluconazole injection, Nystatin oral suspension (unavailable)
    • Antiparasitic drugs: Pentamidine isethionate
    • Antiretroviral drugs: Nelfinavir tablets
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection (unavailable), Valganciclovir oral powder for solution
    • Vaccines: Hepatitis A virus vaccine inactivated, Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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 detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages

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. If you received this message from a colleague, subscribe now.
 

April 2019
 

Improved Sanford Guide Organization & Features

• Web Edition* and mobile apps for Antimicrobial Therapy and Collection:
  • Activity Spectra tables may now be accessed from the main menu level on both the web edition and mobile app.
  • The Tables & Tools menu has been reorganized to correspond with the categories and structure found on drug pages.
  • A new drug-drug interaction (DDI) table can be found in Tables & Tools under Drug Interactions.

New Drug Approvals

• Dovato (dolutegravir 50 mg + lamivudine 300 mg), a two-drug fixed-dose regimen for the treatment of HIV-1 infection in adults who are ARV treatment-naive with no known or suspected resistance mutations to DTG or 3TC. Recommended dosage: one tablet once daily, with or without food.

New or Updated Treatment Guidelines

• Guidelines on the optimization of beta-lactam treatment in ICU patients from The French Society of Pharmacology and Therapeutics (SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) (Crit Care 23:104, 2019). The guidelines are available on the journal website.
• Guidelines for empiric and targeted antimicrobial therapy of complicated intra-abdominal infections (cIAI) from the 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology (BMC Infect Dis 19:293, 2019). The guidelines are availalbe on the journal website.
• Updated clinical guidelines for the diagnosis and treatment of HIV/AIDS in HIV-Infected Koreans from the Committee for Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS of the Korean Society for AIDS (Infect Chemother 51:77, 2019). These guidelines update the 2015 version are are available on the journal website.
• Clinical management guidelines for the management of acute appendicitis in adults from the Eastern Association for the Surgery of Trauma (J Trauma Acute Care Surg 2019 Mar 22 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention and management of blastomycosis, histoplasmosis and coccidioidomycosis in the pre- and post-transplant period from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 29 [Epub ahead of print]).
• Updated guidelines for the management of vancomycin-resistant enterococci (VRE) infections in solid organ transplant candidates and recipients from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 26 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention and management of diarrhea in the pre- and post-transplant period from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 26 [Epub ahead of print]).
• Updated clinical practice guidelines for the management of asymptomatic bacteriuria from the Infectious Diseases Society of America (Clin Infect Dis 2019 Mar 21 [Epub ahead of print]). These guidelines update the 2005 version and are available on the IDSA website.
• Updated guidelines for the management of Clostridioides (Clostridium) difficile infection in surgical patients from the World Society of Emergency Surgery (World J Emerg Surg 14:8, 2019). These guidelines update the 2015 version and are available on the journal website.
• Position statement on the management of hepatitis C virus infection in patients with chronic kidney disease from a joint committee of the Italian Association for the Study of the Liver (AISF), Italian Society of Internal Medicine (SIMI), Italian Society of Infectious and Tropical Disease (SIMIT), and the Italian Society of Nephrology (SIN) (Infection 47:141, 2019).
• Updated guidelines for the management of sepsis in neutropenic cancer patients from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO) (Ann Hematol 2019 Feb 22 [Epub ahead of print]). The guidelines update the 2013 version and are available on the journal website.
• Guidelines for the treatment and management of women living with HIV in the UK during pregnancy and postpartum, and their infants, from the British HIV Association (HIV Med 20 Suppl 3:s2, 2019). The guidelines are available on the journal website.
• Clinical practice guidelines for the provision, monitoring and support of pre-exposure prophylaxis (PrEP) for the prevention of
  HIV acquisition from the British HIV Association and the British Association for Sexual Health and HIV (HIV Med 20 Suppl 2:s2, 2019). The guidelines are available on the journal website.
• Updated guidelines for the diagnosis, prevention and management of cryptococcosis in the pre- and post-transplant period from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 22 [Epub ahead of print]).
• Updated guidelines for the epidemiology, diagnosis, and management of Aspergillus in solid organ transplant recipients from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 21 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention and management of tissue and blood protozoal infections in the pre- and post-transplant period from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 21 [Epub ahead of print]).
• Updated guidelines for the diagnosis and management of pneumonia in the post-transplant period from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 21 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of adenovirus infection after solid organ transplantation from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 12 [Epub ahead of print]).
• Updated guidelines on BK polyomavirus infection, replication, and disease from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 12 [Epub ahead of print]).
• Updated guidelines for the epidemiology, diagnosis, and management of emerging fungal infections in solid organ transplant recipients from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 12 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of herpes simplex virus infection in the pre- and post-transplant period from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 12 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of HHV-6A, HHV-6B, HHV-7, and HHV-8 in the pre- and post-transplant period from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Mar 7 [Epub ahead of print]).
• Updated guidelines for the screening, diagnosis, prevention, and treatment of cytomegalovirus in organ transplant recipients, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines on potential drug-drug interactions between anti-infectives and immunosuppressants, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of tuberculosis in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of Nocardia infections after solid organ transplantation, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of RNA respiratory viral infections in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).

From CDC

• Now that IV quinidine has been discontinued by the manufacturer and is no longer available, artesunate (the WHO-recommended first-line treatment) is now first-line treatment for severe malaria in the US. IV artesunate is neither FDA-approved nor commercially available in the US, but it has been available from CDC since 2007. For details on how to obtain IV artesunate and other FAQs a Malaria Notice has been posted.

Weekly Practice Pearls

• In resource-limited countries, prolonged treatment courses of amphotericin B for infections such as cryptococcal meningitis in patients with HIV can be challenging to administer safely and effectively. In a phase 2 noninferiority trial conducted in Tanzania and Botswana, induction therapy with a single dose of liposomal amphotericin B (10 mg/kg) in combination with high-dose oral fluconazole (1200 mg daily for 2 weeks) was well tolerated and found to be noninferior to 2 weeks of once-daily liposomal amphotericin B (3 mg/kg) plus oral fluconazole for the primary outcome measure of mean rate of fungal clearance from the CSF. This short-course treatment strategy is now being studied in a phase 3 clinical endoint trial (Clin Infect Dis 68:393, 2019).

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of April 7, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since March 31]: None
  • [Shortage recently resolved]: Ciprofloxacin injection
  • [Continue to be in reduced supply]:
    • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
    • Carbapenems: Meropenem injection
    • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable), Erythromycin 0.5% ophthalmic ointment
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
    • Antifungal drugs: Amphotericin B injection (unavailable), Clotrimazole 10 mg oral troches, Fluconazole injection, Nystatin oral suspension (unavailable)
    • Antiparasitic drugs: Pentamidine isethionate
    • Antiretroviral drugs: Nelfinavir tablets (unavailable)
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection (unavailable), Valganciclovir oral powder for solution
    • Vaccines: Hepatitis A virus vaccine inactivated, Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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 detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages

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. If you received this message from a colleague, subscribe now.
 

March 2019

New or Updated Treatment Guidelines

• Updated guidelines for the screening, diagnosis, prevention, and treatment of cytomegalovirus in organ transplant recipients, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines on potential drug-drug interactions between anti-infectives and immunosuppressants, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of tuberculosis in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of Nocardia infections after solid organ transplantation, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of RNA respiratory viral infections in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of viral hepatitis in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Feb 28 [Epub ahead of print]).

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of March 2, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since February 17]: Erythromycin 0.5% ophthalmic ointment
  • [Shortage recently resolved]: Ciprofloxacin injection
  • [Continue to be in reduced supply]:
    • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
    • Carbapenems: Meropenem injection
    • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable)
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
    • Antifungal drugs: Amphotericin B injection (unavailable), Fluconazole injection, Nystatin oral suspension (unavailable)
    • Antiparasitic drugs: Pentamidine isethionate
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection (unavailable), Valganciclovir oral powder for solution
    • Vaccines: Hepatitis A virus vaccine inactivated, Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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 detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages

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. If you received this message from a colleague, subscribe now.
 

February 2019

Post-licensure Safety Surveillance of Shingrix

• Recombinant adjuvanted zoster vaccine (RZV, Shingrix) was approved in October 2017. It is indicated for prevention of herpes zoster (shingles) in adults aged 50 years and older. The recommended administration schedule is two 0.5 mL intramuscular (IM) doses, given 2-6 months apart. RZV is supplied as two vials that must be combined before administration; one contains the lyophilized antigen and the other contains the liquid adjuvant suspension component. After licensure, CDC and FDA began safety monitoring of RZV in the Vaccine Adverse Event Reporting System (VAERS), a national passive surveillance system for adverse events after administration of US-licensed vaccines.
• The initial safety data from VAERS for the first 8 months of vaccine use, when approximately 3.2 million doses were distributed, are consistent with the safety profile observed in prelicensure clinical trials. VAERS received 4,381 reports of adverse events, a reporting rate of 136 reports per 100,000 doses. Only four reports per 100,000 doses were classified as serious. Pyrexia was reported most frequently (23.6%), followed by injection site pain (22.5%), injection site erythema (20.1%), chills (19.3%), headache (16.7%), fatigue (16.0%), and myalgia (12.1%).  230 vaccination error reports were submitted during the analytic period. 143 (62.2%) of the reports were administration errors, most commonly incorrect route (subcutaneous rather than IM); other errors were administration of only the adjuvant and mixing the lyophilized antigen in the wrong diluent. In several reports, health care providers did not administer the second dose of RZV because of a local or systemic reaction, although such reactions are not unexpected; the effectiveness of a single dose of RZV is not known. Overall, these data concerning postlicensure safety data of RZV are reassuring. Adverse reactions are self-limited and generally should not affect completion of the 2-dose series (Morb Mortal Wkly Rep 68:91, 2019).

Antimicrobial Stewardship

• The routine use of antibiotics in asthma exacerbation is not recommended, but we know it happens frequently. The evidence addressing this issue is limited. In a retrospective cohort study of 19,811 patients hospitalized for an asthma exacerbation treated with corticosteroids in 542 acute care hospitals in the US over a two-year period, 8,788 (44.4%) received antibiotics initiated within the first two days of hospitalization (and prescribed for a minimum of two days). The most frequently prescribed antibiotics were macrolides, fluoroquinolones, and third-generation cephalosporins. Compared to patients who did not receive antibiotics, antibiotic-treated patients had a significantly longer hospital stay, higher risk of antibiotic-associated diarrhea, and higher cost of hospitalization. The risk of treatment failure (initiation of mechanical ventilation, transfer to the ICU after day 2, in-hospital mortality, or readmission for asthma) was similar in both groups. These findings support the recommendations of current clinical treatment guidelines and illustrate the need for further research to improve antimicrobial stewardship in asthma (JAMA Intern Med 2019 Jan 28 [Epub ahead of print]).

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of February 2, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list]: Amphotericin B injection, Pentamidine isethionate (Nebupent) for inhalation
  • [Shortage recently resolved]: Oxacillin injection, Penicillin G Procaine injection
  • [Continue to be in reduced supply]:
    • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
    • Carbapenems: Meropenem injection
    • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable)
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
    • Antifungal drugs: Fluconazole injection, Nystatin oral suspension (unavailable)
    • Antiparasitic drugs: None
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection, Valganciclovir oral powder for solution
    • Vaccines: Hepatitis A virus vaccine inactivated, Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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 detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages

 
Sperryville, VA – Sanford Guide, the leading reference for the treatment of infectious diseases, celebrates its fiftieth year in 2019 with a renewed focus on providing clinically actionable guidance through digital platforms. While the company continues to update its ubiquitous print guides annually, advances in technology have enabled the development of market-leading mobile apps, a content delivery API, customizable apps for antimicrobial stewardship guidelines, a responsive web platform, and other tools that provide continually updated information to clinicians at the point of care.
 
In an effort to facilitate the adoption and use of local guidelines and antibiograms, Sanford Guide recently developed Stewardship Assist™, an innovative tool that enables antimicrobial stewardship programs to disseminate guidelines via web and app in real time. Paired with Sanford Guide’s comprehensive information, these local guidelines improve patient care and facilitate the appropriate use of antibiotics.
 
With the launch of the Sanford Guide API in 2017, guidelines became available through electronic health records, clinical surveillance platforms, diagnostic lab reports, and other healthcare IT packages. Serving Sanford Guide content in real time, Sanford Guide API provides guidelines seamlessly integrated within the clinical workflow.
 
At its inception in 1969, Sanford Guide creator Jay P. Sanford, M.D. had little idea of the impact his seminal reference guide would have for generations of health care providers. What began as a series of tables that would describe and compare the newer antibiotics available in the late 1960s evolved over time into the expansive resource relied upon by over a million practitioners worldwide.
 
Sanford Guide remains a family-owned enterprise and collaborative effort, integrating the expertise of its nine-member editorial board and the many practitioners around the world who contact us each year with questions and comments. David N. Gilbert, M.D., the longest-serving member of the Sanford Guide editorial board, expressed the sentiment best when he described his service on the editorial board as “a rare and humbling privilege for which I am eternally grateful.” “Our mission in 2019 remains true to the original purpose in 1969: to provide health care professionals with concise, accessible guidance for making appropriate treatment decisions in an increasingly complex world” said Jeb C. Sanford, Managing Editor. The Sanford Guide team takes great pride in the company’s work over the past fifty years, and looks forward to continued success in the next fifty.
 
Press Contact: Scott Kelly, Vice President, 540-987-9480