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October ‘26 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Oct 13th 2026

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board and our AMS Program Manager.

Links marked with a * are available with a Sanford Guide Antimicrobial Digital Subscription. All other links are available without a Sanford Guide subscription.

Article of the Month (Editors' Choice)

Diagnosis and Treatment of UTI in Children from 8 Days to 5 Years of Age*

By Andrew T. Pavia, M.D.

  • The American Academy of Pediatrics has just released an updated clinical practice guideline (Pediatrics 2026;158:e2026078565) for the diagnosis and treatment of urinary tract infections in children 8 days to 5 years of age. The previous guideline was issued in 2011, so this is a timely update that makes several major changes. These changes are based on evolving evidence reviewed using GRADE, a need to remove race-based recommendations, and a need to harmonize the guidelines for febrile infants with the UTI guidelines. The new recommendations are intended to decrease unnecessary antibiotic exposure by avoiding treatment of asymptomatic bacteriuria and shortening treatment course.
  • The guidelines were released along with three companion technical reports which review the evidence and limitations covering diagnosis (Pediatrics 2026;158:e2026078566), treatment and prevention (Pediatrics 2026;158:e2026078568), and the role of imaging (Pediatrics 2026;158:e2026078567).
  • Key changes that will be of interest to clinicians include:
    • Expansion of the age range from children 2 months to 24 months to include children 8 days to 5 years.
    • Revisions to the criteria for diagnosing high probability of UTI in children who are not medically complex focusing evidence of pyuria but reducing the colony count threshold for culture of urine obtained by sterilely placed catheter or suprapubic aspiration. The definitions include clues before culture results are available and criteria once culture is available.

Age

0 to <2 mon

High index of suspicion before culture

≥5 WBC/hpf OR ≥trace LE

Once culture results are available

Pyuria (as before) and ≥10,000 CFU/mL of a pathogenic organism

 

Age

2 mon to 5 yrs

High index of suspicion before culture

≥10 WBC/hpf OR ≥2+ LE

Once culture results are available

≥5 WBC/hpf or ≥1+ LE AND ≥10,000 CFU/mL of a pathogenic organism for catheter or suprapubic aspiration. If a true clean catch: pyuria as above AND ≥100,000 CFU/mL of a pathogenic organism
    • Recommended antibiotic courses are shorter for most children.
      • 5-7 days for children 2-24 months.
      • 3-5 days for children older than 2 years old with normal anatomy without signs and symptoms suggestive of pyelonephritis (e.g., temp ≥102.2°F).
      • 5-7 days for children older than 2 years old with normal anatomy with signs and symptoms suggestive of pyelonephritis (e.g., temp ≥102.2°F).
    • Early transition to oral therapy once clinical improvement.
    • Renal/bladder ultrasound is recommended after first febrile UTI to identify structural abnormalities.
    • Voiding cystourethrography (VCUG) is NOT recommended after first febrile UTI if anatomy is normal. VCUG should be done after second febrile UTI.
    • Routine continuous antimicrobial prophylaxis is not recommended for children with milder forms of vesicular ureteral reflux while awaiting urology referral.
    • Evaluate and treat bowel/bladder dysfunction in children with UTI.
  • As with all guidelines, the authors point out that they do not replace the need for clinical judgement.

New Drug Approvals

  • Pritelivir (Hovilpri), indicated in immunocompromised adults for the treatment of mucocutaneous lesions caused by herpes simplex virus (HSV) infection that is refractory (with or without documented resistance) to treatment with acyclovir, valacyclovir, or famciclovir. Active against both HSV-1 and HSV-2. Pritelivir prevents de novo synthesis of viral DNA via inhibition of the HSV helicase-primase complex. The most common adverse effect (>5%) is headache. Recommended dosage: 400 mg po on day 1, then 100 mg once daily (with or without food) until HSV lesions have healed. Product availability: 100 mg tablets.

New or Updated Guidelines

  • Infective endocarditis: diagnosis, antibiotic therapy, and management: a scientific statement from the American Heart Association (Circulation 2026; Sep 8. doi: 10.1161/CIR.0000000000001466 [online ahead of print]). Since the publication of the 2015 statement, the incidence of endocarditis has increased, its epidemiology has changed, and novel diagnostic and treatment options have become available. Updated case definitions, non-culture-based pathogen identification methods, and advanced multimodality imaging techniques have emerged. PDF available for download.
  • Guidelines for the management of invasive group A streptococcal infections in children, from the European Society for Pediatric Infectious Disease (Pediatr Infect Dis J 2026;45:e457-e470). Evidence is limited due to the rarity of infection, small sample sizes and heterogeneous study designs, so most recommendations are based on expert opinion.
  • A consensus-based guideline for personalized bacteriophage therapy (Nat Med 2026; Sep 21. doi: 10.1038/s41591-026-04654-6 [online ahead of print]). PDF available for download.
  • Belgian guidance 2026 on management of pregnancy and breastfeeding in women living with HIV and their infants (Eur J Obstet Gynecol Reprod Biol 2026 Sep:325:115312). This is an annual update and is available online.
  • South African HIV Clinicians Society guideline on doxycycline post-exposure prophylaxis to prevent bacterial sexually transmitted infections (South Afr J HIV Med 2026;27:1844). PDF available for download.
  • The updated clinical practice guidelines for the diagnosis and treatment of UTI in children 8 days to 5 years of age are discussed as the Article of the Month (above).

Antimicrobial Stewardship

Long-term Impact of Handshake Stewardship

  • A retrospective study evaluated the impact of handshake stewardship on antimicrobial use at a pediatric hospital.
  • The handshake stewardship intervention included one physician and one pharmacist conducting review of all orders for antimicrobials and in-person rounding. Hospital-wide antimicrobial use was measured over a 12 year period including pre and post-implementation.
  • The number of patients/orders reviewed increased from a median of 1,269 patients/1,718 orders monthly in the first year to 1,825 patients/2,378 orders monthly in year twelve. There was one intervention for every 11.4 orders, and the acceptance rate was 88.5%. Days of therapy per 1,000 patient days declined 33% over the twelve year period with an estimated -0.28% slope change per month (p < 0.001). A reduction was observed in all antibacterial agents except ceftriaxone, linezolid, and antipseudomonal cephalosporins.
  • Antimicrobial stewardship programs should consider incorporating handshake stewardship programs as a strategy to improve antimicrobial use. Antimicrob Steward Healthc Epidemiol. 2026;6(1):e297. doi:10.1017/ash.2026.10863.

Antimicrobial Shortages (US)

  • New shortages:
    • Aztreonam injection (Pfizer) 1 gm, 2 gm vials (23 Sep 2026)
    • Mafenide acetate cream (22 Sep 2026)
  • Resolved shortages:
    • Peginterferon alfa-2a (Pegasys)
  • Antimicrobial drugs recently discontinued: 
    • Imipenem-cilastatin-relebactam, US market (23 Sep 2026)
  • 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)
      • 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)
        • Benzylpenicilloyl polylysine [Pre-pen] (19 Mar 2026)
        • Chloramphenicol injection (9 Oct 2023)
        • Neomycin and Polymyxin B sulfates GU irrigant (25 Jun 2023)
        • Rifaximin 200 mg tablets (11 Apr 2024)
        • Tuberculin skin test (PPD) (21 Aug 2026)
      • 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)
        • Penicillin G benzathine/Penicillin G procaine (31 Mar 2023)
    • Antifungal drugs: 
      • Amphotericin B Lipid Complex (5 Aug 2022)
      • Ibrexafungerp 150 mg tablets (3 Dec 2024)
    • Antimycobacterial drugs: 
      • Rifampin injection (26 Jul 2026)
    • 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)
      • 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 October 2026.
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