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November '25 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Nov 11th 2025

Article of the Month (Editors' Choice) 

Association of 2024-2025 COVID-19 Vaccine with COVID-19 Outcomes in US Veterans (N Engl J Med 2025;393:1612)

Summary by Michael S. Saag, MD

  • Large observational cohort study among veterans in the VA system (Sept 3, 2024 - Dec 31, 2024).
    • 164,132 participants received SARS-CoV-2 vaccination and influenza vaccination at the same time.
    • Comparator group: 131,839 participants who received influenza vaccination only.
  • Follow up: 180 days or first occurrence of COVID-19 symptoms/events.
  • The COVID-19 vaccine was:
    • 29.3% (95% CI, 19.1-39.2%) effective against COVID-19-associated ED visits.
    • 39.2% (95% CI, 21.6-54.5%) effective against COVID-19-associated hospitalizations.
    • 64.0% (95% CI, 23.0-85.8%) effective against COVID-19 deaths.
  • The COVID-19 vaccine was associated with decreased risk of all outcomes across prespecified subgroups (age <65 years, 65 to 75 years, and >75 years), the presence or absence of major co-existing conditions, and immunocompetence status.

Bonus Article

Durability of 2024-2025 COVID-19 Vaccines Against JN.1 Subvariants (JAMA Intern Med 2025:e255465 [online ahead of print]).

Summary by Michael S. Saag, MD

  • Individual-level data on COVID-19 outcomes among recipients of the 2024-2025 mRNA vaccine (KP.2 strain of JN.1 variant).
  • 1.8 million persons in Nebraska identified in the Nebraska Electronic Disease Surveillance System.
  • Vaccine effectiveness against:
    • Symptomatic infection was 44.7% (95% CI, 37.7-50.9%).
    • ED visits was 45.1% (95% CI, 28.9-57.6%).
    • Hospitalization or death was 57.3% (95% CI, 42.6-68.1%).
  • Peak effect for all outcomes was observed at 4 weeks post-vaccination.
    • Symptomatic infection protection dropped to 16.7% (95% CI, 8.4-24.2%) by week 20.
    • ED visit protection dropped to 39.1% (95% CI, 13.4-57.2%) by week 20.
    • Hospitalization or death protection dropped to 34.0% (95% CI, 7.0-53.1%) by week 20.
  • This study confirms the benefit of SARS-CoV-2 vaccination against more current omicron variants and underscores the protection against hospitalization/death among vaccine recipients.

Recent Drug Approvals

  • Fosfomycin disodium (Contepo), already available in multiple countries, was approved by the US FDA in October 2025 for the intravenous treatment of adults with complicated UTI (including pyelonephritis) caused by susceptible strains of E. coli and K. pneumoniae. Fosfomycin inhibits MurA (UDP-N-acetylglucosamine-enolpyruvyltransferase), which catalyzes the first committed step in peptidoglycan synthesis. Recommended dose of the US product*: 6 gm IV (over 1 hr) q8h for up to 14 days. The drug is notable for its high sodium content, 14.3 mEq (330 mg) per gram, which may result in hypernatremia, hypokalemia, hypomagnesemia, and hypophosphatemia. 

New or Updated Guidelines

Antimicrobial Stewardship

Global Antibiotic Consumption, a Stewardship Opportunity 

  • A recent study investigated patterns of antimicrobial use and resistance after the endorsement of the Global Action Plan on Antimicrobial Resistance (GAP-AMR) in 2015.
  • Using a pharmaceutical sales record database, antibiotic consumption from 2010-2021 was evaluated based on the World Health Organization Assess Watch, Reserve (AWaRe) framework and stratified by country income levels. Employing the WHO target for Access-group antibiotics of more than 60% of consumption, antibiotic appropriateness was compared. Antibiotic resistance rates for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, and Enterococcus faecium were taken from the European Antimicrobial Resistance Surveillance Report for the same time period.
  • For the time period evaluated, the eight countries of west Africa, China, and Algeria had the highest annual growth rate of antibiotic consumption while Singapore, South Africa, and Finland had the largest annual decline. Consumption decreased in most high income countries (90%) and increased in low/middle income countries (80%). Amoxicillin was the most frequently used antibiotic, and carbapenem use increased by 54% from 2011 to 2021. A positive association was found between antibiotic consumption and resistance. 
  • The gaps highlighted by this study provide opportunities for local antimicrobial stewardship programs to strengthen their efforts around appropriate antibiotic use. Programs could consider using the upcoming World Antimicrobial Awareness Week to spread awareness to providers and the public about antibiotic use and resistance. Lancet Glob Health. 2025 Nov;13(11):e1880-e1891.

Antimicrobial Shortages (US)

  • New shortages:
    • Oxacillin injection (4 Nov 2025)
  • Resolved shortages:
    • Mefloquine 250 mg tablets (18 Sep 2025)
  • 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)
      • 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.
      • Chloramphenicol injection (9 Oct 2023)
      • Fluoroquinolones:
        • 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
        • Penicillin G benzathine/Penicillin G procaine (31 Mar 2023) Availability update
        • 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)
      • 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: 
      • 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)
  • For more information including estimated resupply dates, see ASHP Drug Shortages website.
  • Data shown are current as of 7 Nov 2025.
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