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January '26 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Jan 13th 2026

Article of the Month (Editors' Choice)

Should empiric antibiotics be routinely prescribed for CAP patients who test positive for respiratory viruses?
By Henry F. Chambers, MD

  • The 2025 American Thoracic Society (ATS) Clinical Practice Guidelines for diagnosis and management of community-acquired pneumonia (CAP)(Am J Respir Crit Care Med 2025 Jul 18 [online ahead of print]) include conditional recommendations for prescribing empiric antibiotics for adult outpatients with comorbidities or adult inpatients with non-severe CAP who test positive for a respiratory virus. The Infectious Diseases Society of America declined to endorse the ATS guidelines (Clin Infect Dis 2025 Dec 4:ciaf625 [online ahead of print]) because of these two recommendations out of concern that use of empiric antibiotics in these settings is not evidence-based, may be more harmful than beneficial, and would increase the overuse of antibiotics.
  • The results of a retrospective study conducted by Biebelberg and colleagues (Clin Infect Dis 2025 Dec 11:ciaf687 [online ahead of print]) of hospitalized patients age 18 years and older with possible CAP and a positive respiratory virus test provide much needed information for clinicians deciding whether or not to prescribe empiric antibiotics for patients with possible CAP who test positive for a respiratory virus. In a propensity-weighted analysis comparing 1720 patients treated with very short courses of antibiotics (0-2 days) to 894 patients treated for 5-7 days, there were no significant differences in hospital length of stay (11.7 days vs 11.1 days), in-hospital mortality (9.5% vs 9.8%), ICU admission after 48 hours (28.3% vs 28.2%), 30-day hospital-free days (16.9 vs 17.0), C. difficile infection within 90 days (0.4% vs 0.4%), or acute kidney injury within 14 days (10.0% vs 11.6%). Similar findings were obtained in sensitivity analyses examining specific virus types, comparing short course cutpoints of 0 days or 0-1 days vs 5-7 days of antibiotics, and including patients with high procalcitonin values (these patients were excluded from the primary analysis).
  • The results of this study argue against routinely prescribing antibiotics for hospitalized patients with CAP (and by extension, outpatients) who test positive for respiratory viruses. Most patients with CAP who test positive for a respiratory virus do not have a bacterial coinfection. An individualized approach that takes into account severity of illness and clinical and laboratory features for and against bacterial coinfection when deciding whether or not to prescribe antibiotics appears to be safe.

Recent Drug Approvals

  • Zoliflodacin (Nuzolvence)* is a first-in-class spiropyrimidinetrione antibacterial indicated for the treatment of uncomplicated urogenital gonorrhea in patients ≥12 years of age (weight ≥35 kg). Zoliflodacin targets bacterial type II topoisomerases, like fluoroquinolones, but in a different way (limiting cross-resistance). The drug is generally well tolerated. A pregnancy test should be obtained in females of reproductive potential before beginning treatment, due to the possibility of fetal harm (based on animal data). Zoliflodacin is a CYP3A4 substrate, so co-administration with moderate or strong CYP3A4 inducers is not recommended. The recommended dose is 3 gm po as a single dose. Product availability: 3 gm packets of oral granules.
  • Gepotidacin (Blujepa)*, previously approved for uncomplicated UTI, is now also approved for treatment of uncomplicated urogenital gonorrhea in patients ≥12 years of age (weight ≥45 kg) who have limited or no alternative treatment options. The recommended dose for gonorrhea is 3000 mg po q12h x2 doses.

New or Updated Guidelines

Antimicrobial Stewardship

Rapid Blood Culture Diagnostics Intervention

  • A recent study evaluated the feasibility, acceptability, and appropriateness of an antimicrobial stewardship (AMS) intervention paired with a rapid diagnostic test (RDT). The RDT was performed on the first blood culture with Gram-positive bacteria identified on Gram stain in a pediatric hospital.
  • The intervention involved real-time responses to the RDT results by the AMS team 24 hours a day, 7 days a week. An on-call AMS clinician or trainee was notified of the RDT results through an automated electronic medical record alert. After reviewing the results and patient-specific factors, the AMS member contacted the clinician by telephone with recommendations. A standardized guidance document was used for recommendations and dosing based on the RDT result and illness severity. An educational session was also provided to clinicians to describe the new process.
  • Time to optimal antimicrobial therapy was reduced from 20.3 hours pre-intervention to 1.3 hours post intervention (p=0.002). There were no differences in hospital length of stay, duration of bacteremia, or mortality between the intervention periods. The AMS team recommended discontinuation in over half of the interventions (72/125), and vancomycin was the most frequent agent recommended to stop. Recommendations were accepted in 94% of cases.
  • AMS teams may consider the use of a similar intervention combined with RDT to improve the time to optimal antimicrobial therapy. Antimicrob Steward Healthc Epidemiol. 2025 Nov 26;5(1):e313. doi: 10.1017/ash.2025.10225. 

Antimicrobial Shortages (US)

  • New shortages:
    • Acyclovir injection (16 Dec 2025)
    • Azithromycin injection (6 Jan 2026)
  • Resolved shortages:
    • Metronidazole injection (23 Dec 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)
      • Cephalosporins:
        • Cefazolin injection (4 Jun 2018)
        • Cefdinir, all formulations (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.
      • 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 (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: 
      • 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 11 January 2026.
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