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February '24 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Feb 13th 2024

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board and our AMS Program Manager. Links marked with a * are available to Sanford Guide Web Edition and All Access clients. All other links are available without a Sanford Guide subscription. To receive monthly updates via email, sign up now. 

February 2024

SARS-CoV-2 / COVID-19

CDC Syphilis Testing Recommendations

  • Approximately six million new cases of syphilis occur globally each year. A syphilis epidemic is occurring in the US, with sustained increases in primary and secondary syphilis from 5,979 cases reported in 2000 to 133,945 cases reported in 2020. This epidemic is characterized by health disparities, particularly among sexual and gender minority populations, intersections with the HIV and substance use epidemics, and increased morbidity and mortality due to congenital infection. The US CDC has published new recommendations for syphilis testing, including laboratory-based tests, point-of-care tests, processing of samples, and reporting of test results (MMWR Recomm Rep 2024;73(1):1-35). PDF available here.

AMS Pearl: ABX Order Sets & Use Metrics

  • A recent study assessed the impact of electronic antibiotic order sets on antibiotic use over a 5-year period at a single academic medical center. Order sets were developed and deployed in the electronic medical record for the empiric treatment of community-acquired pneumonia, urinary tract infection, skin and soft-tissue infection, and others. The antibiotic recommendations were based on national guidelines, the local antibiogram, and the hospital formulary.
  • There was a significant decrease in the Standardized Antibiotic Administration Ratio (SAAR) from phase 1 to phase 5 driven largely by a reduction in broad-spectrum agents used for hospital-onset infections. There was also a significant decrease in the days of therapy per 1,000 patient days, fluoroquinolone orders, carbapenem orders, and clindamycin orders.
  • Antimicrobial stewardship programs could use the findings from this study to support the development of electronic antibiotic order sets. Infect Control Hosp Epidemiol. 2024;doi: 10.1017/ice.2023.293.

Drug Shortages (US)

  • Bicillin-LA and Bicillin-CR availability: See Dear Healthcare Professional letter here.
  • New shortages:
    • Isoniazid injection 100 mg/mL (24 Jan 2024)
  • Shortages recently resolved:
    • Cefixime capsules 400 mg (9 Jan 2024)
  • Antimicrobial drugs or vaccines in continued reduced supply or unavailable (as of 12 Feb 2024) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
    • Antibacterial drugs:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection (22 Feb 2021)
        • Tobramycin injection
      • Bacitracin ophthalmic ointment
      • Carbapenems:
        • Meropenem injection
      • Cephalosporins:
        • Cefazolin injection (4 Jun 2018)
        • Cefdinir, all oral formulations (29 Jun 2023)
        • Cefixime 400 mg capsules (21 Jan 2022)
        • Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Provepharm Life Solutions and its distributor Direct Success. Click here for details).
      • Chloramphenicol injection (9 Oct 2023)
      • Clindamycin phosphate injection (25 Jun 2015)
      • Doxycycline oral suspension (16 Nov 2021)
      • Fluoroquinolones:
        • Ciprofloxacin injection (13 Jan 2023)
        • Ciprofloxacin 0.3% ophthalmic solution
        • Levofloxacin oral solution, 25 mg/mL (15 Sep 2023)
        • Moxifloxacin 400 mg tablets (6 Dec 2023)
        • Ofloxacin 0.3% ophthalmic solution
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection (1 Jun 2015)
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1%
        • Erythromycin 0.5% ophthalmic ointment (8 Jul 2022)
      • Metronidazole injection (20 Oct 2021)
      • Neomycin and Polymyxin B Sulfates GU Irrigant (25 Jun 2023)
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Amoxicillin. all oral formulations (18 Oct 2022)
        • Amoxicillin-clavulanate, all oral formulations (17 Nov 2022)
        • Ampicillin injection (19 Oct 2023)
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Penicillin G benzathine injection (Bicillin-LA) (1 Feb 2023)
        • Penicillin G benzathine/Penicillin G procaine (Bicillin-CR) (31 Mar 2023)
        • Penicillin VK tablets (250 mg, 500 mg), oral solution (250 mg/5 mL) (17 May 2023)
        • Piperacillin-tazobactam injection
      • Polymyxin B sulfate/Trimethoprim sulfate ophthalmic solution (31 Mar 2023)
      • Sulfacetamide 10%/Prednisolone sodium phos 0.23% oph soln (21 Sep 2023)
      • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs: 
      • Amphotericin B injection (10 Nov 2022)
      • Amphotericin B Lipid Complex (5 Aug 2022)
      • Nystatin topical powder (18 Aug 2023)
    • Antimycobacterial drugs: 
      • Isoniazid 100 mg, 300 mg tablets (1 Sep 2022)
      • Rifampin capsules
    • Antiparasitic drugs:
      • Primaquine
    • Antiviral drugs: 
      • Nirsevimab-alip injection (24 Oct 2023)
      • Oseltamivir capsules, powder for oral suspension (1 Nov 2022)
      • Podofilox 0.5% topical gel
      • Ribavirin for inhalation solution (23 May 2023)
      • Valganciclovir tablets, powder for oral solution (7 Feb 2023)
    • Vaccines:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Posaconazole oral susp 40 mg/mL (Dec 2023, by Merck)
    • Sulfacetamide 10%/Prednisolone acetate 0.2% oph ointment (Aug 2023 by Allergan, sole supplier)
    • Penicillin G procaine 600,000 units/mL IM injection (Jun 2023)
    • Ritonavir oral solution 80 mg/mL (Jan 2023)
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