July '24 Infectious Diseases Update
Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Jul 9th 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 All Access & Sanford Guide for Web clients. All other links are available without a Sanford Guide subscription. To receive monthly updates via email, sign up now.
JULY 2024
COVID-19 Vaccine
- CDC has officially recommended that everyone ≥6 months of age, whether or not they have ever previously been vaccinated with a COVID-19 vaccine, receive an updated 2024-25 vaccine this fall.
- Detailed guidelines will be published as soon as the new vaccines are available. Antigenic composition:
- KP.2 for Moderna and Pfizer mRNA vaccine.
- JN.1 for Novavax recombinant protein vaccine (not approved for age <12 years).
- The current 2023-2024 vaccine formulation and guidelines should be followed until then.
- KP.2 for Moderna and Pfizer mRNA vaccine.
- JN.1 for Novavax recombinant protein vaccine (not approved for age <12 years).
RSV Vaccine
- As of June 2024, three RSV vaccines (Arexvy [GSK], Abrysvo [Pfizer], mRESVIA [Moderna]) are FDA-approved, with ACIP guidelines in place.
- In clinical trials, vaccine effectiveness (VE) of a single dose in the first and second year against severe outpatient disease were, respectively, Abrysvo 86% and 74%, Arexvy 79% and 59%, and mRESVIA 55% and 36%.
- Real-world observational data for hospitalization from US hospitals during winter 2023-24 showed:
- For both Arexvy and Abrysvo, VE was approximately 80% against RSV-associated hospitalization, ED visits and critical illness.
- mRESVIA was unavailable during winter 2023-24.
- Excess cases of Guillain-Barre Syndrome are seen with Abrysvo and, to a lesser extent, Arexvy, but so far not with mRESVIA.
- Risk-benefit analysis is vastly in favor of vaccination per these indications:
- All adults >75 years of age.
- Adults 60–74 years of age with certain chronic medical conditions or other factors that increase risk of severe RSV disease.
- NOT recommended for adults 60–74 years of age who are not at increased risk of severe RSV.
- In clinical trials, vaccine effectiveness (VE) of a single dose in the first and second year against severe outpatient disease were, respectively, Abrysvo 86% and 74%, Arexvy 79% and 59%, and mRESVIA 55% and 36%.
- Real-world observational data for hospitalization from US hospitals during winter 2023-24 showed:
- For both Arexvy and Abrysvo, VE was approximately 80% against RSV-associated hospitalization, ED visits and critical illness.
- mRESVIA was unavailable during winter 2023-24.
- Excess cases of Guillain-Barre Syndrome are seen with Abrysvo and, to a lesser extent, Arexvy, but so far not with mRESVIA.
- Risk-benefit analysis is vastly in favor of vaccination per these indications:
- All adults >75 years of age.
- Adults 60–74 years of age with certain chronic medical conditions or other factors that increase risk of severe RSV disease.
- NOT recommended for adults 60–74 years of age who are not at increased risk of severe RSV.
AMS Pearl: Antimicrobial Stewardship in Neonates
- A recently published systematic review and meta-analysis of 70 studies evaluated the effectiveness of antimicrobial stewardship (AMS) in neonates admitted to neonatal intensive care units (NICU) or postnatal wards.
- Moderate-certainty evidence suggests that after AMS intervention, there was a significant reduction in the initiation of antimicrobial agents and duration of therapy across the included studies. There was low-certainty evidence for a reduction in drug resistance, cost, and sustainability of AMS with no increase in rates of antimicrobial reinitiation or sepsis-related mortality.
- Antimicrobial stewardship teams can use the findings from this study to expand efforts in the neonatal population. Pediatrics. 2024;153(6):e2023065091. doi:10.1542/peds.2023-065091
Antimicrobial Shortages (US)
- New shortages:
- Nystatin oral suspension (21 June 2024)
- Shortages recently resolved:
- Amphotericin B injection (6 July 2024)
- Antimicrobial drugs or vaccines in continued reduced supply or unavailable (as of 7 July 2024) 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 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. Click here for details.
- Chloramphenicol injection (9 Oct 2023)
- Clindamycin phosphate injection (25 Jun 2015)
- Fluoroquinolones:
- Ciprofloxacin injection (13 Jan 2023)
- Levofloxacin injection in D5W (29 May 2024)
- Levofloxacin oral solution, 25 mg/mL (15 Sep 2023)
- Moxifloxacin 400 mg tablets (6 Dec 2023)
- Ofloxacin 0.3% ophthalmic solution (22 Dec 2022)
- Glycopeptides, glycolipopeptides, lipopeptides:
- Vancomycin injection (1 Jun 2015)
- Macrolides/azalides:
- 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 (5 Jun 2018)
- Penicillins:
- Amoxicillin, all oral formulations (18 Oct 2022)
- Amoxicillin-clavulanate, all oral formulations (17 Nov 2022)
- Ampicillin injection (19 Oct 2023)
- Dicloxacillin 250 mg, 500 mg capsules (18 Aug 2021)
- Nafcillin injection (20 Mar 2024)
- Penicillin G benzathine injection (1 Feb 2023) Availability update here
- Penicillin G benzathine/Penicillin G procaine (31 Mar 2023) Availability update here
- Penicillin VK oral solution 250 mg/5 mL (17 May 2023)
- Penicillin VK 250 mg, 500 mg tablets (17 May 2023)
- Polymyxin B sulfate/Trimethoprim sulfate ophthalmic solution (31 Mar 2023)
- Rifaximin 200 mg tablets (11 Apr 2024)
- Antifungal drugs:
- Amphotericin B Lipid Complex (5 Aug 2022)
- Antimycobacterial drugs:
- Isoniazid 100 mg, 300 mg tablets (1 Sep 2022)
- Isoniazid injection 100 mg/mL (24 Jan 2024)
- Antiparasitic drugs:
- Nitazoxanide oral susp 100 mg/5 mL (15 Feb 2024)
- Antiviral drugs:
- Acyclovir injection (21 Feb 2024)
- Oseltamivir 30 mg, 45 mg, 75 mg capsules (1 Nov 2022)
- Oseltamivir powder for oral suspension (1 Nov 2022)
- Ribavirin for inhalation solution (23 May 2023)
- Valganciclovir powder for oral solution (7 Feb 2023)
- Valganciclovir 450 mg tablets (7 Feb 2023)
- 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)
- For more detailed information including estimated resupply dates, see https://www.ashp.org/Drug-
Shortages/
- Nystatin oral suspension (21 June 2024)
- Amphotericin B injection (6 July 2024)
- Antibacterial drugs:
- Aminoglycosides:
- Gentamicin injection (22 Feb 2021)
- 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. Click here for details.
- Chloramphenicol injection (9 Oct 2023)
- Clindamycin phosphate injection (25 Jun 2015)
- Fluoroquinolones:
- Ciprofloxacin injection (13 Jan 2023)
- Levofloxacin injection in D5W (29 May 2024)
- Levofloxacin oral solution, 25 mg/mL (15 Sep 2023)
- Moxifloxacin 400 mg tablets (6 Dec 2023)
- Ofloxacin 0.3% ophthalmic solution (22 Dec 2022)
- Glycopeptides, glycolipopeptides, lipopeptides:
- Vancomycin injection (1 Jun 2015)
- Macrolides/azalides:
- 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 (5 Jun 2018)
- Penicillins:
- Amoxicillin, all oral formulations (18 Oct 2022)
- Amoxicillin-clavulanate, all oral formulations (17 Nov 2022)
- Ampicillin injection (19 Oct 2023)
- Dicloxacillin 250 mg, 500 mg capsules (18 Aug 2021)
- Nafcillin injection (20 Mar 2024)
- Penicillin G benzathine injection (1 Feb 2023) Availability update here
- Penicillin G benzathine/Penicillin G procaine (31 Mar 2023) Availability update here
- Penicillin VK oral solution 250 mg/5 mL (17 May 2023)
- Penicillin VK 250 mg, 500 mg tablets (17 May 2023)
- Polymyxin B sulfate/Trimethoprim sulfate ophthalmic solution (31 Mar 2023)
- Rifaximin 200 mg tablets (11 Apr 2024)
- Aminoglycosides:
- Antifungal drugs:
- Amphotericin B Lipid Complex (5 Aug 2022)
- Antimycobacterial drugs:
- Isoniazid 100 mg, 300 mg tablets (1 Sep 2022)
- Isoniazid injection 100 mg/mL (24 Jan 2024)
- Antiparasitic drugs:
- Nitazoxanide oral susp 100 mg/5 mL (15 Feb 2024)
- Antiviral drugs:
- Acyclovir injection (21 Feb 2024)
- Oseltamivir 30 mg, 45 mg, 75 mg capsules (1 Nov 2022)
- Oseltamivir powder for oral suspension (1 Nov 2022)
- Ribavirin for inhalation solution (23 May 2023)
- Valganciclovir powder for oral solution (7 Feb 2023)
- Valganciclovir 450 mg tablets (7 Feb 2023)
- 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)