Jul '22 Infectious Disease Update

Jul 12th 2022

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. 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.
 

July 2022 

SARS-CoV-2 / COVID-19

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

  • July 6: The US FDA revises the nirmatrelvir + ritonavir (Paxlovid) EUA to authorize state-licensed pharmacists to prescribe to eligible patients, with certain limitations to ensure appropriate patient assessment and prescribing (press release here). Under the limitations outlined in the authorization, the state-licensed pharmacist should refer patients for clinical evaluation with a physician, advanced practice registered nurse, or physician assistant licensed or authorized under state law to prescribe drugs, if any of the following apply:
    • Sufficient information is not available to assess renal and hepatic function.
    • Sufficient information is not available to assess for a potential drug interaction.
    • Modification of other medications is needed due to a potential drug interaction.
    • Nirmatrelvir + ritonavir is not an appropriate therapeutic option based on the current Fact Sheet for Healthcare Providers or due to potential drug interactions for which recommended monitoring would not be feasible.
  • COVID-19 vaccination in cancer patients: preliminary recommendations from NCCN here.
  • Currently authorized vaccines. See COVID-19 Prevention for table summarizing use and data.
  • ESCMID COVID-19 living guidelines: drug treatment and clinical management (Clin Microbiol Infect 2021 Nov 22 [online ahead of print]). Available at PMC.
  • Guidelines on COVID-19 diagnosis, serology, treatment and management, and infection prevention: IDSA and NIH.
  • Living WHO guideline on drugs for COVID-19 (BMJ 2021;375:n2936).
  • Living WHO guideline on drugs to prevent COVID-19 (BMJ 2021;372:n526). Available here.
  • Living WHO guideline on prophylaxis against COVID-19 (BMJ 2021;373:n949). Available at PMC.
  • Management of hospitalized adults with COVID-19: a European Respiratory Society living guideline (Eur Respir J 2021;57(4):2100048). Available at PMC.

New IDSA Guidance on Treatment of Resistant Infections

  • Guidance document for treating AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia infections (Clin Infect Dis 2022;74:2089-2114). PDF available here.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of July 11, 2022) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since June 13, 2022:
      • Erythromycin 0.5% ophthalmic ointment
    • Shortage recently resolved:
      • Acyclovir injection, Amphotericin B injection, Ethambutol tablets
    • Antibacterial and antimycobacterial drugs in continued reduced supply:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection
        • Neomycin tablets
        • Tobramycin injection
      • Carbapenems:
        • Meropenem injection
      • Cephalosporins:
        • Cefazolin injection
        • Cefepime injection
        • Cefixime 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
        • Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1% (unavailable)
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules
        • Piperacillin-tazobactam injection
      • Quinupristin-Dalfopristin injection
      • Topical (miscellaneous) antibacterials:
        • Bacitracin ophthalmic ointment
        • Neomycin and Polymyxin B sulfates GU irrigant
        • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
        • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs in continued reduced supply: 
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs in continued reduced supply: 
      • Rifampin capsules
      • Rifampin injection
      • Rifapentine tablets
    • Antiviral drugs in continued reduced supply: 
      • Tocilizumab injection
    • Vaccines in continued reduced supply:
      • None
  • Antimicrobial drugs recently discontinued: 
    • 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)
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