null Skip to main content

December '25 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Dec 9th 2025

Article of the Month (Editors' Choice) 

By Michael S. Saag, MD

In honor of World AIDS Day (December 1), this month's focus is "The HIV/AIDS pandemic: Where are we now?" In this editorial review published in September (AIDS 2025;39(11):1497-1504), Chris Beyrer and colleagues sound the alarm that the global HIV/AIDS response is facing its most serious crisis in decades. Specifically, they highlight:

  • Despite the global expansion of antiretroviral therapy and the growing availability of pre-exposure prophylaxis (PrEP), progress toward the UNAIDS targets has stalled.
    • HIV incidence remains high.
    • Treatment gaps persist.
    • Preventable deaths continue.
  • The abrupt suspension of US foreign aid programs (especially USAID) has disrupted service delivery programs that were established over the last two decades to serve marginalized populations around the world.
  • The editorial reviews the underlying structural, institutional, political, and programmatic failures that led to missed targets, and highlights the immediate threat to those programs that were working well before the sudden, catastrophic cessation of US foreign aid programs.
  • Beyrer, et al., argue that the path forward requires renewed political will, reforms, and a commitment to sustainable funding in a moment of increasing global polarization and shrinking public health budgets.

Beyrer and his team (Ratevosian, Beyrer, Chola, et al.) followed up on their editorial review with a Perspective published in the New England Journal of Medicine on December 4, 2025 (N Engl J Med 2025;393(22):2180-82). In this piece, the authors focus specifically on the present administration's "America First Global Health Strategy," which prioritizes US "homeland" initiatives with goals of protecting the country from outbreaks while boosting its economy, and marketing its scientific innovations globally. The plan commits to maintaining funding for front-line healthcare workers and commodities at current levels for 6 months. After the bridge period, the strategy proposes multiyear, bilateral compacts with 71 supported countries, with agreements targeted by 31 December 2025 (!) and implementation by April 2026. Ratevosian, et al., point out the risks introduced by this plan that could threaten global health progress. They make constructive suggestions, encouraging the US to focus on improved efficiencies in delivery of US health aid, which currently spends ~60% on overhead costs. A major suggestion is to shift toward universal health coverage and integrated national systems. PEPFAR, in particular, would be more efficient focusing its funding on provision of core services and reducing overhead expenditures. They further argue that the US strategic goal of preventing outbreaks "from reaching the shores of America or harming Americans living abroad" will require more than bilateral compacts alone. Stronger support for Global South-led regional institutions would preserve the benefits of multilateral coordination while advancing shared accountability and efficiencies.

Both of these articles are "must reads" for those interested in global health and the HIV/AIDS pandemic, in particular.

New or Updated Guidelines

Antimicrobial Stewardship In Nursing Homes

  • Recently published guidance for infection prevention and control (IPC) in nursing homes includes a section on antimicrobial stewardship (AMS). The recommendations suggest the implementation of an AMS program through a partnership between the infection preventionist, clinical leaders, and the pharmacy.
  • Effective strategies for AMS programs incorporate antimicrobial use protocols, monitoring antimicrobial use, prescriber feedback, staff and provider education, and peer comparison. Medication review should be performed during care transitions to assess antimicrobial appropriateness and duration of therapy. Nursing homes may consider forming partnerships with local hospitals or infectious diseases providers to supplement their AMS programs. Suggested metrics for monitoring include days of therapy or antimicrobial starts each month.
  • Nursing homes and skilled nursing facilities should consider incorporating the recommendations from this guidance document to enhance their AMS programs and efforts. Infect Control Hosp Epidemiol. 2025 Oct 28;46(11):1-28.

Antimicrobial Shortages (US)

  • New shortages:
    • None
  • Resolved shortages:
    • Mefloquine 250 mg tablets (18 Sep 2025)
  • Antimicrobial drugs recently discontinued: 
    • Bezlotoxumab injection (31 Jan 2025, by Merck)
  • 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)
      • Bacitracin ophthalmic ointment 500 units/gm (12 Sep 2024)
      • Cephalosporins:
        • Cefazolin injection (4 Jun 2018)
        • Cefdinir 300 mg capsules (29 Jun 2023)
        • Cefdinir 125 mg/5 mL, 250 mg/5 mL oral suspension (29 Jun 2023)
        • 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.
      • Chloramphenicol injection (9 Oct 2023)
      • Fluoroquinolones:
        • Levofloxacin injection in D5W (29 May 2024)
        • Levofloxacin oral solution, 25 mg/mL (15 Sep 2023)
        • 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 oral suspension, 1 gm packets (20 Nov 2024)
        • Erythromycin lactobionate injection (23 Apr 2025)
      • Neomycin and Polymyxin B sulfates GU irrigant (25 Jun 2023)
      • Nitrofurantoin oral suspension (5 Jun 2018)
      • Nitroimidazoles:
        • Metronidazole injection (20 Oct 2021)
      • 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 oral solution 250 mg/5 mL (17 May 2023)
        • Penicillin VK 250 mg, 500 mg tablets (17 May 2023)
      • Rifaximin 200 mg tablets (11 Apr 2024)
    • 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: 
      • Oseltamivir 30 mg, 45 mg, 75 mg capsules (1 Nov 2022)
      • Oseltamivir powder for oral suspension (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 5 Dec 2025.
!