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April '26 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Apr 21st 2026

Article of the Month (Editors' Choice) 

Initial Vancomycin Taper for the Prevention of Recurrent Clostridioides difficile Infection

By Brian S. Schwartz, M.D.

  • Recurrent Clostridioides difficile infection (CDI), generally defined as the recurrence of diarrhea and a positive confirmatory test within 8 weeks after treatment of an initial episode, occurs in about 20% of patients. Recurrence rates increase with each subsequent episode. Recurrent CDI is notoriously difficult and expensive to treat.
  • McDonald and colleagues (JAMA Netw Open 2026;9:e2560495) report the TAPER-V trial, a multicenter, double-blind randomized trial conducted at 12 Canadian hospitals evaluating whether an initial 4-week vancomycin pulse-and-taper regimen reduces recurrent CDI compared with a 2-week vancomycin pulse regimen alone in adults with a first episode or first recurrence. All participants first received 14 days of vancomycin 125 mg four times daily, after which they were randomized to 2 additional weeks of tapering vancomycin or placebo. The primary outcome was CDI recurrence by day 56.
  • The trial was stopped early due to recruitment difficulties, leaving 265 patients in the final analysis rather than the planned 500. At day 56, recurrence occurred in 14.8% of the taper group and 17.7% of controls, corresponding to an adjusted relative risk of 0.84 with a 95% Bayesian credible interval of 0.48 to 1.45 and a posterior probability of superiority of 73.8%. At day 38, however, recurrence was lower with tapering vancomycin, 6.7% versus 15.4%, while by day 90 the apparent benefit had disappeared, with recurrence rates of 17.0% and 18.5%, respectively. Adverse effects were infrequent and similar between groups.
  • While the randomized, blinded, placebo-controlled design is a major strength, the findings should be interpreted cautiously. The study was underpowered because of early termination, and the primary endpoint at day 56 was not convincingly positive. The stronger signal appeared at day 38, a secondary outcome, suggesting that the intervention may have delayed rather than prevented recurrence, a conclusion supported by the waning separation of the Kaplan-Meier curves and the lack of difference by day 90. Taken together, the results suggest a transient effect rather than a durable clinical benefit.

  • In practice, an initial vancomycin taper appears safe and may reduce early relapse, but this trial does not show clear long-term prevention of recurrence. Accordingly, fidaxomicin should remain the preferred first-line therapy when accessible. The most balanced takeaway is that vancomycin taper may offer a short-term advantage by postponing recurrence in some patients, but the evidence here falls short of proving a durable benefit.

RSV Vaccines

  • All three RSV vaccines (Abrysvo [Pfizer], Arexvy [GSK], mResvia [Moderna]) are now approved for use in individuals 18 through 59 years of age who are at increased risk for lower respiratory tract disease caused by RSV.
  • The IDSA recommendation to use the vaccine in this group has been published (Clin Infect Dis 2026 Mar 2:ciag117 [online ahead of print]).

New or Updated Guidelines

Antimicrobial Stewardship

Antimicrobial Stewardship in Hospital-at-Home Programs

  • A review paper on behalf of the Society of Infectious Diseases Pharmacists describes the role of antimicrobial stewardship (AMS) in Hospital-at-Home (HaH) programs.
  • While most AMS interventions used in acute caring settings translate to the HaH model, some situations may require the development of new processes. For example, response time related to diagnostics and provider availability may limit the ability to make quickchanges to antibiotic regimens.
  • The patient transition to the HaH setting provides an opportunity to reassess the antibiotic regimen and identify opportunities for optimization. Other interventions may involve recommending regimens that require less frequent visits in the home including oral conversions, once daily administrations, or continuous infusions.
  • AMS programs may need to adapt reporting metrics used in ambulatory care settings and/or focus on the disease states most commonly treated in the HaH model.
  • Antimicrobial stewardship teams should consider adopting the recommendations from this paper when expanding services to HaH patients. JACCP 9, no. 3 (2026): e70185,

Antimicrobial Shortages (US)

  • New shortages:
    • Benzylpenicilloyl polylysine [Pre-pen] (19 Mar 2026)
  • Resolved shortages:
    • Cefdinir, all formulations (5 Mar 2026)
  • Antimicrobial drugs recently discontinued: 
    • None
  • Antimicrobial drugs or vaccines in continued reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
    • Antibacterial drugs:
      • Aminoglycosides:
        • Gentamicin injection (22 Feb 2021)
      • Cephalosporins:
        • Cefazolin injection (4 Jun 2018)
        • Cefotaxime injection (10 Jun 2015)
          • FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Provepharm Life Solutions and its distributor Direct Success.
      • Fluoroquinolones:
        • Levofloxacin injection in D5W (29 May 2024)
        • Levofloxacin oral solution, 25 mg/mL (15 Sep 2023)
        • Moxifloxacin injection (13 Jan 2026)
        • Moxifloxacin 400 mg tablets (6 Dec 2023)
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection (1 Jun 2015)
      • Lincosamides:
        • Clindamycin phosphate injection (25 Jun 2015)
      • Macrolides, azalides:
        • Azithromycin injection (6 Jan 2026)
        • Azithromycin oral suspension, 1 gm packets (20 Nov 2024)
        • Erythromycin lactobionate injection (21 Apr 2025)
      • Miscellaneous
        • Bacitracin ophthalmic ointment 500 units/gm (12 Sep 2024)
        • Chloramphenicol injection (9 Oct 2023)
        • Neomycin and Polymyxin B sulfates GU irrigant (25 Jun 2023)
        • Nitrofurantoin oral suspension (5 Jun 2018)
        • Rifaximin 200 mg tablets (11 Apr 2024)
      • Oxazolidinones:
        • Linezolid injection (16 Oct 2024)
      • Penicillins:
        • Amoxicillin, all oral formulations (18 Oct 2022)
        • Amoxicillin-clavulanate, all oral formulations (17 Nov 2022)
        • Dicloxacillin 250 mg, 500 mg capsules (18 Aug 2021)
        • Oxacillin injection (4 Nov 2025)
        • Penicillin G benzathine injection (1 Feb 2023) Availability update
        • Penicillin G benzathine/Penicillin G procaine (31 Mar 2023) Availability update
        • Penicillin VK, all oral formulations (17 May 2023)
    • Antifungal drugs: 
      • Amphotericin B Lipid Complex (5 Aug 2022)
      • Ibrexafungerp 150 mg tablets (3 Dec 2024)
    • Antimycobacterial drugs: 
      • No current shortages
    • Antiparasitic drugs:
      • Nitazoxanide oral susp 100 mg/5 mL (15 Feb 2024)
    • Antiviral drugs: 
      • Acyclovir injection (16 Dec 2025)
      • Oseltamivir, all formulations (1 Nov 2022)
      • Peginterferon alfa-2a (Pegasys) (8 Jan 2025)
      • Ribavirin for inhalation solution (23 May 2023)
  • For more information including estimated resupply dates, see ASHP Drug Shortages website.
  • Data shown are current as of 18 April 2026.
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