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June '25 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Jun 10th 2025

Article of the Month (Editors' Choice)

Zoster Vaccine Reduces the Risk of Dementia

By Henry F. Chambers, MD

  • One in three individuals will develop shingles (herpes zoster) in his or her lifetime, and the risk increases with age, particularly in those over 50. The CDC recommends shingles vaccine for adults age 50 years and older. Shingrix, a recombinant vaccine of varicella-zoster virus glycoprotein E antigen, is the only zoster vaccine currently available in the US for prevention of shingles. Recombinant vaccine has replaced the outdated live-attenuated varicella-zoster vaccine (Zostavax) due to its higher and more durable efficacy. Recombinant vaccine is recommended even for those previously administered Zostavax. Recombinant vaccine provides excellent protection (over 90%) against shingles and postherpetic neuralgia (its most common complication) in adults over age 50 with healthy immune systems. Protection is long lasting (at least 7 years after vaccination). Recombinant vaccine is also effective in adults age 19 and older with weakened immune systems, for whom it is also recommended.
  • It turns out that shingles vaccination has another benefit: reduced risk of a new dementia diagnosis. A study by Eyting et al (Nature 2025;641(8062):438-446) took advantage of a health services administrative decision in Wales to determine eligibility for the live-attenuated zoster vaccine on the basis of an individual's exact date of birth. Those born before September 2, 1933 were ineligible and remained so for life, whereas those born on or after September 2, 1933 were eligible to receive the vaccine. The investigators compared the rate of dementia diagnosis in individuals who were one week too old to be eligible for the vaccine (vaccination rate of 0.01%) to the rate in individuals who were just one week younger (vaccination rate of 47.2%). This roll-out of zoster vaccine created a natural experiment closely resembling conditions of an actual randomized controlled trial, since individuals born one week before September 2, 1933 were unlikely to differ substantially from those born one week after this date.
  • The probability of a new dementia diagnosis over a follow-up period of 7 years was reduced by 3.5%, corresponding to a 20% relative reduction (95% CI 6.5-33.4%, p=0.02).
  • Using claims data from the Optum Labs Data Warehouse database, a retrospective cohort study in the US of 4.5 million individuals age 50 and older found a similar protective effect with recombinant zoster vaccine (i.e., Shingrix). Compared to unvaccinated individuals (overall, only 1.3% had been previously vaccinated with Zostavax), completion of the two-dose recombinant vaccine series conferred a 32% decrease in dementia risk (95% CI 30-33%, p<0.001) over a 5-year follow-up period (Vaccine 2025;46:126673).
  • Neurotropic herpesviruses, and herpes zoster virus in particular, have been associated with dementia, providing biological plausibility to these studies. The mechanism of this protective effect of zoster vaccine, whether direct, due to its protection from herpes zoster reactivation and its other complications (e.g., neuroinflammatory effects, vasculopathy), off-target (by eliciting a broader immune response), or both, remains to be elucidated. Regardless, such strong evidence that shingles vaccine has a significant protective effect against development of dementia is yet another reason to encourage all adults who are over age 50 to be vaccinated against shingles.

New Drug Approval

  • Clesrovimab-cfor (Enflonsia, Merck) for the prevention of RSV lower respiratory tract disease in neonates and infants who are born during or entering their first RSV season. Clesrovimab-cfor is an extended half-life monoclonal antibody that targets the extracellular domain of the RSV fusion (F) protein to prevent fusion of the viral and cellular membranes and viral entry. The recommended dose is 105 mg IM, regardless of weight. The duration of protection provided by a single dose extends through 5 months.

Antimicrobial Stewardship - Antibiogram Subgroup Stratification

  • A recently published study from a quaternary-care academic center evaluated the differences in antibiotic susceptibilities between a hospital-wide antibiogram and unit or specimen-specific stratified antibiograms. 
  • The emergency department antibiogram demonstrated higher susceptibilities while the intensive care unit and transplant unit antibiograms had reduced susceptibilities compared to the hospital-wide antibiogram. For specimen-specific antibiograms, there were differences in susceptibilities for urine, respiratory, and blood that varied by unit.
  • Stewardship programs in collaboration with the microbiology lab could consider producing specimen-specific antibiograms to better guide empiric therapy decisions. Ann Clin Microbiol Antimicrob 2025 Apr 5, 24:21. 

New or Updated Guidelines

  • Update of guidelines for management of community-acquired pneumonia in adults, from The French Infectious Diseases Society (SPILF) and the French Language Pulmonology Society (SPLF), in collaboration with the French Societies of Microbiology (SFM), Emergency Medicine (SFMU), Radiology (SFR), and Intensive Care Medicine (SRLF), along with representatives of general practice (Respir Med Res 2025;87:101161). This is an update of the 2010 guidelines. PDF available here.
  • Guidelines for complicated urinary tract infections in children: a review by the European Society for Pediatric Infectious Diseases (Pediatr Infect Dis J 2025;44:e211-e223). PDF available here.

Antimicrobial Shortages (US)

  • Recent shortages:
    • None
  • Recently resolved shortages:
    • Cidofovir injection (3 Jun 2025) NEW
    • Isoniazid 100 mg, 300 mg tablets (16 May 2025) NEW
    • Nafcillin injection (23 May 2025) NEW
  • 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)
      • Bacitracin ophthalmic ointment 500 units/gm (12 Sep 2024)
      • 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)
      • 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)
      • 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 (23 Apr 2025)
      • Neomycin and Polymyxin B sulfates GU irrigant (25 Jun 2023)
      • Nitrofurantoin oral suspension (5 Jun 2018)
      • Nitroimidazoles:
        • Metronidazole injection (20 Oct 2021)
      • 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)
        • Penicillin G benzathine injection (1 Feb 2023) Availability update here
          • Temporary importation of Extencilline from France: click here
          • Temporary importation of Lentocilin from Portugal: click 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)
      • Rifaximin 200 mg tablets (11 Apr 2024)
    • Antifungal drugs: 
      • Amphotericin B Lipid Complex (5 Aug 2022)
      • Fluconazole injection (9 Aug 2024)
      • Ibrexafungerp 150 mg tablets (3 Dec 2024)
      • Nystatin oral suspension (21 June 2024)
    • Antimycobacterial drugs: 
      • Rifapentine 150 mg tablets (25 Feb 2025)
    • Antiparasitic drugs:
      • Mefloquine 250 mg tablets (14 May 2024)
      • Nitazoxanide oral susp 100 mg/5 mL (15 Feb 2024)
    • Antiviral drugs: 
      • Oseltamivir 30 mg, 45 mg, 75 mg capsules (1 Nov 2022)
      • Oseltamivir powder for oral suspension (1 Nov 2022)
      • Peginterferon alfa-2a (Pegasys) (8 Jan 2025)
      • Ribavirin for inhalation solution (23 May 2023)
  • Antimicrobial drugs recently discontinued: 
    • Bezlotoxumab injection (31 Jan 2025, by Merck)
    • 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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