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Jan '23 Infectious Disease Update

Jan 10th 2023

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board and Antimicrobial Stewardship Program Manager. Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal. To sign up for ID updates to your inbox, register here.

January 2023

Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.

Updated Practice Guidelines

Lenacapavir Approved

  • The US FDA has approved Sunlenca (lenacapavir) for the treatment of HIV-1 infection (in combination with other ARVs) in heavily treatment-experienced adults with multidrug-resistant HIV-1 infection failing their current ARV regimen due to resistance, intolerance, or safety considerations. Lenacapavir is a first-in-class HIV-1 capsid inhibitor. Initiation dosage is administered as oral tablets and subcutaneous injections, followed by maintenance sc injections every six months.

Antimicrobial Stewardship Pearl

  • A retrospective surveillance study conducted at four hospitals in Kentucky analyzed fluoroquinolone use and associated susceptibility data. The interventions studied were order-set revisions to discourage routine use of fluoroquinolones and prospective audit and feedback provided by infectious diseases pharmacists. Fluoroquinolone use decreased 74% over a 5-year period from 2016-2020 while susceptibilities for both Pseudomonas aeruginosa and Escherichia coli increased by 57% and 15%, respectively, over a 10-year period. This study demonstrates how changes to an order-set and prospective audit and feedback, interventions that can be implemented in any setting, were successful in reducing use and decreasing resistance. It provides evidence for implementing prospective audit and feedback as one method to be adherent with the new elements of performance for antibiotic stewardship from the Joint Commission that became effective January 1, 2023 for hospitals and critical access hospitals. Antimicrob Steward Healthc Epidemiol. 2022 Nov 16;2(1):e186. doi: 10.1017/ash.2022.326.

Deuterated Drugs

  • A deuterated drug is a drug in which deuterium replaces one or more hydrogen atoms in the drug. The C-D bond is known to be stronger than the C-H bond. Because the breaking of C-H bonds is so common during oxidative (phase I) drug metabolism, deuteration alters drug pharmacokinetics and metabolism. Selective replacement with deuterium may result in beneficial changes in the biological effects of a drug, such as less frequent dosing (owing to decreased rate of metabolism) or reduced formation of a toxic metabolite (Expert Opin Ther Pat 2014;24:1067).VV116 is a deuterated, tri-isobutyrate ester prodrug of the remdesivir parent nucleoside. Following oral administration, it is rapidly metabolized to the parent nucleoside, which is then converted to the active triphosphorylated metabolite by intracellular kinases (Acta Pharmacologica Sinica 2022;43:3130). This metabolite acts as an analog of adenosine triphosphate and competes for incorporation into nascent RNA chains by SARS-CoV-2 RNA-dependent RNA polymerase.

    In a recently published trial, 822 symptomatic adults with mild-to-moderate COVID-19 at high risk of progression were randomized to a five-day course of oral VV116 or nirmatrelvir-ritonavir (Paxlovid). VV116 was noninferior to nirmatrelvir-ritonavir in shortening the time to sustained clinical recovery. The incidence of adverse events was lower in the VV116 group (N Engl J Med 2022 Dec 28 [online ahead of print]).

Drug Shortages (US)

  • CDC HAN (12/14/2022): Guidance in light of reduced availability of oseltamivir (Tamiflu and generic) during high seasonal influenza activity.
  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of January 8, 2023) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New shortages since December 11, 2022:
      • Ofloxacin 0.3% ophthalmic solution
    • Shortage recently resolved:
      • Dalbavancin injection
      • Penicillin G sodium injection
    • Antibacterial drugs:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection
        • Neomycin tablets
        • Tobramycin injection
      • Bacitracin ophthalmic ointment (unavailable)
      • Carbapenems:
        • Meropenem injection
      • Cephalosporins:
        • Cefazolin injection
        • Cefixime 400 mg capsules
        • 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),
        • Ceftazidime injection
        • Cefuroxime injection
      • Clindamycin injection
      • Doxycycline oral suspension
      • Fluoroquinolones:
        • Ciprofloxacin 0.3% ophthalmic solution
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin injection
        • Azithromycin ophthalmic solution 1% (unavailable)
        • Erythromycin 0.5% ophthalmic ointment
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Amoxicillin (all oral formulations)
        • Amoxicillin-clavulanate (all formulations)
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Piperacillin-tazobactam injection
      • Rifaximin 200 mg tablets
      • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
      • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs:
      • Amphotericin B injection
      • Amphotericin B Lipid Complex (ABLC)
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs:
      • Isoniazid 300 mg tablets
      • Rifampin capsules
      • Rifampin injection
      • Rifapentine 150 mg tablets
    • Antiparasitic drugs:
      • Primaquine
    • Antiviral drugs:
      • Oseltamivir capsules, powder for oral suspension
    • Vaccines:
      • None
  • Antimicrobial drugs recently discontinued:
    • Quinupristin-Dalfopristin (discontinued by Pfizer in early 2022, no other supplier)
    • Gemifloxacin 320 mg tablet (August 2022, no further US distribution)
    • Gentamicin sulfate 0.3% ophthalmic ointment (July 2022)
    • Mupirocin calcium 2% cream (Bactroban [GSK], June 2020)
    • Bacitracin injection (February 2020)
    • Interferon alfa-2b (Intron A, October 2019)
    • Mupirocin calcium 2% nasal ointment (Bactroban Nasal [GSK], August 2019)