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Nov '22 Infectious Disease Update

Nov 8th 2022

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.

November 2022


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

  • 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 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.

Visceral Leishmaniasis in Persons Living with HIV

  • Updated WHO guidelines (click here to download PDF) describe the management of visceral leishmaniasis* (VL) caused by Leishmania donovani in HIV co-infected patients in East Africa and South-East Asia. The recommendations are also applicable to other areas endemic for L. donovani.
  • Until now, the generic recommendation for treatment of a VL episode in an HIV co-infected patient was monotherapy with liposomal amphotericin B 3-5 mg/kg IV daily or in 10 intermittent doses (on days 1–5, 10, 17, 24, 31 and 38) to a total dose of 40 mg/kg.
  • New recommendations: Liposomal amphotericin B (up to a cumulative treatment dose of 30 mg/kg, given as 5 mg/kg IV on each treatment day 1, 3, 5, 7, 9, 11) + miltefosine (100 mg/day po for 14 days if acquired in South-East Asia, 28 days if acquired in East Africa).
  • Secondary prophylaxis (vary low certainty of evidence):
    • East Africa: Pentamidine 4 mg/kg [300 mg for an adult] IV q3-4 weeks.
    • South-East Asia: Amphotericin B deoxycholate 1 mg/kg IV q3-4 weeks or liposomal amphotericin B 3-5 mg/kg IV q3-4 weeks. Prophylaxis can be stopped if the CD4 cell count is maintained at >350, or the HIV viral load is undetectable for at least 6 months and there is no evidence of VL relapse.

U.S. Antibiotic Awareness Week

  • U.S. Antibiotic Awareness Week is November 18-24, and November is also C. difficile Awareness Month. Among the key messages related to both campaigns is the importance of talking to patients and families about the potential harms associated with antibiotic use, like allergic reactions, C. difficile, and antimicrobial resistance.
  • A new toolkit recently released by The Agency for Healthcare Research and Quality can help with efforts to improve antibiotic use in ambulatory care settings. This toolkit uses the Four Moments of Antibiotic Decision-Making framework to guide implementation of antimicrobial stewardship in ambulatory care with the ultimate goal of improving antibiotic prescribing.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of November 6, 2022) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since October 9, 2022:
      • Amoxicillin (all oral formulations)
      • Dalbavancin injection
      • Oseltamivir capsules, powder for oral suspension
      • Penicillin G sodium injection
      • Primaquine tablets
    • Shortage recently resolved:
      • Cefepime injection
      • Daptomycin injection
      • Neomycin and Polymyxin B sulfates GU irrigant
      • Rifapentine tablets
    • Antibacterial and antimycobacterial drugs in continued reduced supply:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection
        • Neomycin tablets
        • Tobramycin injection
      • 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),
        • Ceftazidime injection
        • Cefuroxime injection
      • Clindamycin injection
      • Doxycycline oral suspension
      • Fluoroquinolones:
        • Ciprofloxacin 0.3% ophthalmic solution
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1% (unavailable)
        • Erythromycin 0.5% ophthalmic ointment
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Piperacillin-tazobactam injection
      • Quinupristin-Dalfopristin injection
      • Rifaximin 200 mg tablets
      • Topical (miscellaneous) antibacterials:
        • Bacitracin ophthalmic ointment (unavailable)
        • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
        • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs in continued reduced supply
      • Amphotericin B Lipid Complex (ABLC)
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs in continued reduced supply
      • Isoniazid 300 mg tablets
      • Rifampin capsules
      • Rifampin injection
    • Antiviral drugs in continued reduced supply
      • None
    • Vaccines in continued reduced supply:
      • None
  • Antimicrobial drugs recently discontinued: 
    • 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)