August '26 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Aug 12th 2026

Article of the Month (Editors' Choice)

SNAP Judgments

By Henry F. Chambers, M.D.

The SNAP (Staphylococcus aureus Network Adaptive Platform) trial has yielded two landmark studies, both randomized controlled trials and both published in June of this year, comparing outcomes for adult patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia treated with an antistaphylococcal penicillin (ASP) (either flucloxacillin or cloxacillin) to those treated with (1) cefazolin for infection caused by penicillinase-producing, penicillin-resistant S. aureus strains (671 cefazolin-treated patients, 670 ASP-treated patients) (N Engl J Med 2026;394:2329), or (2) benzylpenicillin (penicillin G) for those with penicillin-susceptible S. aureus (PSSA) strains (156 penicillin-treated patients, 125 ASP-treated patients) (Lancet 2026;408:141). The recommended dose of ASP was 2 gm IV q4-6h (q4h for endocarditis or critical illness) for flucloxacillin, and 2 gm IV q4h for cloxacillin. The recommended dose of cefazolin was 2 gm IV q6-8h (q6h for endocarditis or critical illness). The recommended dose of benzylpenicillin was 3 million units IV q4h or 4 million units IV q6h. Actual dosing was at the discretion of the treating physician.
The primary outcome was all-cause mortality at 90 days. Secondary outcomes included microbiological treatment failure, diagnosis of new foci of infection, and acute kidney injury (AKI) after 14 days. Cefazolin and penicillin had efficacy comparable to that of ASPs with mortality of 15% for cefazolin vs. 17% for ASP, and 14% for benzylpenicillin vs. 21% for ASP. Rates of microbiological failure and new foci of infection were low and also similar, 4% vs. 4% and 5% vs. 5%, respectively. Rates of AKI were significantly higher with ASP: 19.6% for ASP versus 13.9% for cefazolin, and 22% for ASP versus 11% for benzylpenicillin. In fact, the trial data and safety monitoring committee recommended terminating the benzylpenicillin versus ASP trial early because of increased rates of AKI in the ASP group.
The SNAP trial comparing cefazolin to ASP confirms the results of the smaller French study (Lancet 2025;406:2349) that cefazolin is just as effective and better tolerated and safer than ASP for treatment of MSSA bacteremia, and a drug of choice. Whether poorer outcomes are associated with MSSA strains exhibiting the cefazolin inoculum effect, an in vitro phenomenon in which the cefazolin broth dilution MIC is >16 µg/ml when the test is performed at an inoculum of 10⁷ colony-forming units per ml, is unanswered, but studies to assess this are underway. However, given the results of the SNAP and French trials, the impact is likely to be small and selective, if any.
With respect to the use of benzylpenicillin to treat PSSA bacteremia, note that patients were enrolled in this trial only if penicillin susceptibility determined by broth dilution or automated testing was confirmed in a second test, either EUCAST or CLSI penicillin zone disc test or by the absence of blaZ (the gene encoding penicillinase) by PCR. Provided that appropriate testing is performed to exclude penicillinase production, benzylpenicillin, as with cefazolin for other MSSA strains, is safer to given than ASP and appears at least to be as effective.

New or Updated Guidelines

Brazilian guidelines for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children (Braz J Infect Dis 2026;30:105946). The last national guideline issued by the Brazilian Society of Infectious Diseases was published in 2013. PDF available.
Evidence-based guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea: 2025 revised edition (Helicobacter 2026;31:e70149). Previous versions were published in 1998, 2013, and 2020. PDF available.
Clinical practice guidelines for long COVID prevention and treatment (Eur Respir J 2026;68:2502611). Evidence-based recommendations are presented. Given the limited and often low-methodological-quality evidence, all recommendations are supported by very low to moderate certainty. PDF available.
British Association of Sexual Health and HIV (BASHH) guidelines on the management of viral hepatitis 2026 (Int J STD AIDS 2026;37:939). Evidence-based recommendations for the prevention, diagnosis and initial management of viral hepatitis A, B, C and D are presented. PDF available.

Extended Duration of Artemether-Lumefantrine Therapy

In July, the CDC extended the duration of artemether-lumefantrine (Coartem)* therapy, the clear drug of choice, to a 5-day regimen for uncomplicated Plasmodium falciparum infections. Reasons include increasing artemisinin resistance worldwide, reports of late recrudescence (2-6 weeks) after 3-day regimens, and treatment failures in persons >65 kg.
The recommended regimen is now:
- Day 1: Initial dose, then second dose 8 hr later
- Day 2-5: Twice-daily dosing
Tablets contain 20 mg artemether and 120 mg lumefantrine.
- Adults: 4 tablets per dose
- Pediatric: 5 to <15 kg, one tablet per dose; 15 to <25 kg, 2 tablets per dose; 25 to <35 kg, 3 tablets per dose; ≥35 kg, 4 tablets per dose.
See also Treatment of Uncomplicated Malaria (CDC).

Antimicrobial Stewardship

Restriction criteria to improve vancomycin use

A single-center study evaluated the impact of a pharmacist-driven intravenous vancomycin restriction on the appropriateness of empiric vancomycin use in a community hospital.
Vancomycin appropriateness was evaluated pre- and post-implementation of a pharmacist-driven protocol to review every empiric intravenous vancomycin order. Orders deemed inappropriate were discontinued and prescribers were notified.
One-hundred patients were included in each group. Vancomycin appropriateness significantly improved post-intervention compared to pre-intervention (97% vs. 55%, p<0.001). Similarly, days of therapy and ordered vancomycin trough levels both decreased. There was no difference seen in 30-day mortality, acute kidney injury, or infusion reactions between groups.
Antimicrobial stewardship teams may consider the use of a restriction protocol for reducing the use of inappropriate empiric therapy. Antimicrob Steward Healthc Epidemiol. 2026 Jul 23;6(1):e224. doi: 10.1017/ash.2026.10808.

Antimicrobial Shortages (US)

New shortages:
- Rifampin injection (26 Jul 2026)
Resolved shortages:
- Oxacillin injection (4 Nov 2025)
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)
  - 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)
    - Benzylpenicilloyl polylysine [Pre-pen] (19 Mar 2026)
    - Chloramphenicol injection (9 Oct 2023)
    - Neomycin and Polymyxin B sulfates GU irrigant (25 Jun 2023)
    - 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)
    - Penicillin G benzathine injection (1 Feb 2023)
    - Penicillin G benzathine/Penicillin G procaine (31 Mar 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 9 August 2026.