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March '26 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Mar 12th 2026

Article of the Month (Editors' Choice) 

Managing complex antiretroviral regimens: "I'd rather switch than fight"

By Michael S. Saag, MD

  • Switching antiretroviral (ARV) therapy in persons with HIV (PWH) who have virologic suppression is commonplace.
  • Most PWH in care since the 1990s and early 2000s have experienced multiple rounds of regimen failure, often associated with resistance conferring mutations (RCMs) to existing ARV agents.
  • The end result is these folks end up on complex antiretroviral therapy (ART) regimens designed to cover the RCMs. 
  • Over the last several years, new high-potency drugs from different ARV classes have been developed that could be used to simplify these complex regimens to something much easier to take.
  • Orkin and colleagues evaluated the efficacy of a novel single tablet regimen, bictegravir-lenacapavir (BIC/LEN), versus continuing a successful, complex, multi-tablet regimen (Lancet 2026;Feb 25:S0140-6736(26)00307-7 [online ahead of print]).
  • Individuals on complex regimens were randomized 2:1 to either the single, daily oral BIC/LEN (75 mg/50 mg) tablet or continue their current complex regimen. The primary endpoint was to see if BIC/LEN was non-inferior to continuing the current successful regimen in keeping the HIV-1 RNA <50 copies/ml after 48 weeks of therapy.
  • Among the 557 participants, 371 were assigned to BIC/LEN and 186 were randomized to remain on their current regimen. BIC /LEN was remarkably successful with only 3 (1%) of those receiving BIC/LEN failing with an HIV-1 RNA value ≥50 copies/ml at week 48, compared to 2 (1%) who had continued their current regimen (-0.3 % difference; 95% CI -2.3% to 1.8%); these results met the criteria of non-inferiority (4%).  No significant difference in adverse events was reported but overall satisfaction was better in the BIC/LEN group.
  • Many other randomized "switch" studies have shown similar findings over the years, but the BIC/LEN study used very liberal inclusion criteria thereby mimicking "real world" scenarios.
  • The majority of patients who are struggling to maintain adherence with their complex, multi-tablet regimens are highly ARV experienced, older, have multiple comorbid conditions, or are experiencing some degree of kidney dysfunction. Figure 2 in the Orkin paper shows the vast diversity of the complex regimens participants were receiving upon entry to the trial.
  • Overall, this study represents a major advance in expanding the options of ARV therapy for highly treatment-experienced PWH who are fighting to remain on complex regimens. In the 1960s and 1970s there was an advertising campaign in the United States for Tareyton cigarettes wherein the slogan, “Us Tareyton smokers would rather fight than switch,” was used. In the case of managing PWH who are highly ARV experienced, the majority would rather switch to a simpler single-tablet ARV regimen than continue to fight the battle of adhering to complex, multi-drug regimens to maintain their HIV treatment success.  Based on the results of this new study, many PWH and their medical providers may now have a green light to switch a new oral single-tablet regimen.

Immunization Update

New or Updated Guidelines

New Formulation: Prezcobix Ped tablets for oral suspension

  • Film-coated tablets for oral suspension containing darunavir 600 mg + cobicistat 90 mg. Indicated for pediatric patients aged ≥3 years weighing 15 kg to <25 kg.
  • Preparation: disperse tablet in 30 mL water, administer immediately. Preparation will appear reddish purple. Ensure entire dose is consumed. Tablets are not to be crushed, chewed, or swallowed.

Antimicrobial Stewardship

Improving Duration of Therapy for Otitis Media

  • A recent research letter described an electronic medical record (EMR) intervention aimed to improve antibiotic duration of therapy in children with acute otitis media (AOM) seen during primary care or emergency department visits. 
  • The goal of the intervention was to improve the proportion of prescriptions written for 10 days for children younger than 2 years and 5-7 days for children 2 years and older. Antibiotic order panels for amoxicillin and amoxicillin-clavulanate were designed to default to the recommended dose, frequency, and duration of therapy based on the patient’s indication and age. 
  • Use of the order panel was associated with a higher proportion of prescriptions written for the guideline-concordant duration of therapy (90.2% vs. 56.1%; p <0.001). The improvement was most notable in children 2 years and older (85.2% vs. 26.3%, p <0.001). 
  • Antimicrobial stewardship teams may consider using order panels in the EMR to promote guideline recommendations for duration of therapy. JAMA Netw Open. 2026 Feb 3;9(2):e2560066.

Antimicrobial Shortages (US)

  • New shortages:
    • None
  • Resolved shortages:
    • Cefdinir, all formulations (5 Mar 2026)
  • 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)
        • 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 injection (13 Jan 2026)
        • 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 injection (6 Jan 2026)
        • 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: 
      • Acyclovir injection (16 Dec 2025)
      • 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 9 March 2026.
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