Mar '23 Infectious Disease Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD on Mar 14th 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

March 2023


  • Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.
  • March 2: A combined COVID/influenza vaccine for the upcoming 2023-2024 season respiratory illness season will likely not be available, but hopefully will be available the following season. according to Peter Marks, MD, PhD. Dr. Marks is Director of the Center for Biologics Evaluation and Research (CBER) at FDA. He made his comments during a recent National Foundation for Infectious Diseases webinar on COVID-19 vaccines. Click here for the webinar.
  • COVID-19 vaccination in cancer patients: 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 2022;28:222). 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.

CDC Health Alert Network

  • March 2: Health Advisory issued to notify clinicians and public health authorities of an increase in the number of cases of chikungunya* reported in Paraguay. Click here for complete advisory.
  • CDC has been monitoring an increase in extensively drug-resistant (XDR) Shigella* infections (shigellosis) reported through national surveillance systems. CDC defines XDR Shigella as strains resistant to all commonly recommended empiric and alternative antibiotics: azithromycin, ciprofloxacin, ceftriaxone, TMP-SMX, and ampicillin. To date, there are no CDC recommendations for treating XDR shigellosis in the US. Click here for the complete advisory.

HBV Screening and Testing

  • Newly released CDC recommendations regarding screening and testing for hepatitis B virus infection (MMWR Recomm Rep 2023;72:1-25). This report updates and expands previously published (2008) recommendations regarding screening for HBV infection in the US. PDF available here.

DT Discontinued

  • Sanofi Pasteur has discontinued production and distribution of Diphtheria and Tetanus Toxoids Adsorbed (DT) and is withdrawing its licenses in all countries. DT was indicated for active immunization against diphtheria and tetanus in children 6 weeks through 6 years of age (prior to 7th birthday). See Sanofi Pasteur's letter to providers here.

New or Update Practice Guidelines

  • Executive summary from the Spanish Society of Infectious Diseases and Clinical Microbiology (and collaborators): Management of patients with suspected or confirmed antibiotic allergy (Enferm Infecc Microbiol Clin (Engl Ed) 2023;41:181-6).
  • From The Society of Bacterial Infection and Resistance of Chinese Medical Association, the Expert Committee on Clinical Use of Antimicrobial Agents and Evaluation of Antimicrobial Resistance of the National Health Commission, the Infectious Diseases Society of Chinese Medical Education Association, and the China Clinical Practice Guideline Alliance: Guidelines for the diagnosis, treatment, prevention, and control of infections caused by carbapenem-resistant gram negative bacilli (J Microbiol Immunol Infect 2023 Feb 18 [online ahead of print]). PDF available here.

Antimicrobial Stewardship Pearl

  • An emergency department quality improvement study evaluated the impact of a pharmacist-run, real-time electronic health record antibiotic dosing report on the number of major delays in subsequent antibiotic administration times.  The report included all orders for antimicrobials within the previous 24 hours and included one-time orders.  Pharmacists used the report along with patient renal function to determine the timing of the next dose of antibiotics. The study found that the frequency of major delays was higher in the control group than the intervention group (27% versus 20%; p=0.047).  These findings demonstrate a feasible strategy for an antimicrobial stewardship intervention in the emergency department.  Am J Health-Syst Pharm 2023; zxad024

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of March 10, 2023) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
    • New shortages since February 10, 2023:
      • None
    • Shortage recently resolved:
      • Ceftazidime injection
      • Cefuroxime injection
      • Dalbavancin 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),
      • Clindamycin injection
      • Doxycycline oral suspension
      • Fluoroquinolones:
        • Ciprofloxacin injection
        • Ciprofloxacin 0.3% ophthalmic solution
        • Ofloxacin 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 oral formulations)
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Penicillin G benzathine injection
        • 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
      • Oseltamivir powder for oral suspension
      • Valganciclovir tablets
      • Valganciclovir powder for oral solution
    • Vaccines:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Ritonavir oral solution 80 mg/mL (January 2023)
    • Lindane 1% shampoo (discontinued by Wockhardt USA in June 2022, no other supplier)
    • 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)