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June 11, 2020

June ID Update

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal. If you received this message from a colleague, subscribe now.
 

JUNE 2020

SARS-CoV-2 / COVID-19

  • Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.
  • Remdesivir remains the treatment option for severe, hospitalized COVID-19.
  • Guidelines on COVID-19 diagnosis, treatment and management, and infection prevention: IDSA and NIH

IV Artesunate FDA approved

  • Artesunate* for Injection has been approved by the US FDA for the initial treatment of severe malaria in adult and pediatric patients. The recommended dosage is 2.4 mg/kg IV at 0, 12, and 24 hours, and thereafter once daily until the patient is able to tolerate oral therapy. Commercial availability is expected in late 2020.

New or Updated Treatment Guidelines

Practice Pearls

  • Non-renal clearance accounts for about 65% of the total clearance of linezolid. Despite this fact, no dosage adjustment for linezolid in hepatic dysfunction is currently recommended. However, a PK modeling study shows that overexposure may result in patients with liver cirrhosis, suggesting the need for a dosage reduction depending on pathogen MIC (Antimicrob Agents Chemother 2020;64: e00133-20).
  • Trimethoprim inhibits the renal tubular secretion of creatinine, causing a fall in creatinine excretion and an increase in the serum creatinine concentration WITHOUT a change in glomerular filtrate rate (GFR). The mechanism is believed to be the inhibition (by TMP) of drug transporters in the proximal tubule (OCT2, OCT3, MATE1, and MATE2-K) also used by creatinine. The expected magnitude of increase is around 30% (Drug Metab Pharmacokinet 2018;33:103).
  • Published data regarding the effect of ECMO on ceftolozane-tazobactam pharmacokinetics are scant. An investigation using both an ex vivo and an in vivo (porcine) model found minimal circuit sequestration and a modest decrease in ceftolozane and tazobactam clearance. The data suggest that no change in ceftolozane-tazobactam dosing in patients undergoing ECMO is warranted, but this recommendation requires confirmation (J Transl Med 2020;18:213).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of June 10, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since May 10Acyclovir injection, Ethambutol tablets, Metronidazole injection
    • Shortage recently resolvedGentamicin ophthalmic ointment
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Gentamicin injection, Tobramycin injection, Tobramycin lyophilized powder for injection
      • Carbapenems: Meropenem injection
      • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Apollo Pharmaceuticals and its distributor FFF Enterprises. Click here for details), Cefoxitin injection, Ceftazidime injection, Cefuroxime injection
      • Clindamycin injection
      • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides: Vancomycin injection
      • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin 0.5% ophthalmic ointment
      • Methanamine hippurate tablets
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: None
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline injection
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Neomycin and Polymyxin B sulfates GU irrigant, Neomycin and Polymyxin B sulfates and Dexamethasone ophthalmic ointment, Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal, antiparasitic, and antiviral drugs in continued reduced supply:
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets and suspension
      • Antiparasitic drugs: Chloroquine tablets, Hydroxychloroquine tablets, Pentamidine isethionate
      • Antiviral drugs: Cidofovir injection
    • Vaccines in coninued reduced supply:
      • Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), Yellow Fever vaccine (YF-VAX is unavailable, but Stamaril can be obtained through a limited number of clinics in the US. Click here).
  • Antimicrobial drugs newly discontinued: 
    • Recent discontinuations: Bacitracin inection (in February 2020), Interferon alfa-2b (Intron A, in October 2019), Quinidine gluconate IV (in December 2017), Terbinafine granules (in May 2017), MenHibrix (in February 2017), Elvitegravir (Vitekta, in December 2016), Peginterferon alfa-2b (in February 2016; 50 mcg vials still available in limited quantities), Boceprevir (in December 2015), Permethrin 1% topical lotion (in September 2015).
May 12, 2020

May ID Update

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal. If you received this message from a colleague, subscribe now.
 

MAY 2020

Free Trials for Hospitals and Health Systems

  • Sanford Guide is currently offering free 60-day trials of Sanford Guide All Access (web & mobile) to hospitals and health systems. Click here for more information.

SARS-CoV-2 / COVID-19

Updated Pediatric HIV Guidelines

  • Updated Guidelines for the Use of Antiretroviral Agents in Pediatric HIV infection from the DHHS Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV are available on the AIDSinfo website.

Other New or Updated Treatment Guidelines

  • British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease (Thorax 2020;75:370). The guidelines are available on the BTS website.
  • Diagnosis and treatment of acute appendicitis: 2020 update of the World Society of Emergency Surgery (WSES) Jerusalem guidelines (World J Emerg Surg 2020;15:27). The guidelines are available on the WJES website.
  • 2020 update of the World Society of Emergency Surgery (WSES) guidelines for the management of acute colonic diverticulitis in the emergency setting (World J Emerg Surg 2020;15:32). The guidelines are available on the WJES website.
  • Clinical practice guidelines for the treatment of left-sided colonic diverticulitis, from the American Society of Colon and Rectal Surgeons (Dis Colon Rectum 2020;63:728). The guidelines are available on the journal website.
  • Position paper on antimicrobial therapeutic drug monitoring in critically ill patients from these endorsing organizations: European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT), and International Society of Antimicrobial Chemotherapy (ISAC) (Intensive Care Med 2020 May 7 [Epub ahead of print]).

Dosing Pearls

  • IV infusion over 30 minutes is the recommended method of ceftriaxone* administration in adults. IV push administration over 1-2 minutes allows for a decrease in time to administration, which might positively affect outcome in a time-sensitive situation such as sepsis. In a retrospective study of 753 administrations in an emergency department, the total adverse event rate with IV push ceftriaxone was 0.13%, similar to or lower than previously reported. A cost savings for the hospital was also realized (Am J Emerg Med 2020 Mar 30 [Epub ahead of print]).
  • The effect of extracorporeal membrane oxygenation (ECMO) on TMP-SMX* pharmacokinetics has not been described. A 33-yo male with recently diagnosed HIV infection and Pneumocystis jirovecii pneumonia requiring venovenous ECMO for refractory respiratory failure was treated with high-dose TMP-SMX. No significant effect on trimethoprim or sulfamethoxazole pharmacokinetics was found, suggesting that no dose adjustment in ECMO may be necessary (Pharmacotherapy 2020 May 7 [Epub ahead of print]).
  • For CMV prophylaxis in solid-organ transplant (SOT) patients, valganciclovir* (a ganciclovir prodrug) is typically given in a dose of 900 mg po q24h. A ganciclovir trough concentration of ≥0.6 µg/mL in this setting is a reasonable target. Until recently, specific valganciclovir dose adjustment data in CRRT have been scant. In a prospective PK study in ten SOT patients receiving CVVHD, eight (80%) achieved the target ganciclovir concentration at steady state using valganciclovir 450 po q24h. The mean ganciclovir concentration was 2.27 µg/mL. Most patients had minimal enteral nutrition during the study period. Neutropenia was not observed; thrombocytopenia was common but likely multifactorial (Clin Infect Dis 2020 May 7 [Epub ahead of print]).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of May 10, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since April 8Erythromycin 0.5% ophthalmic ointment
    • Shortage recently resolvedBenzylpenicilloyl polylysine (Pre-Pen), Ceftazidime/avibactam injection
    • Antibacterial drugs in continued reduced supply:
      • Aminoglycosides: Amikacin injection, Gentamicin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection, Tobramycin lyophilized powder for injection
      • Carbapenems: Meropenem injection
      • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Apollo Pharmaceuticals and its distributor FFF Enterprises. Click here for details), Cefoxitin injection, Ceftazidime injection, Cefuroxime injection
      • Clindamycin injection
      • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides: Vancomycin injection
      • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable)
      • Methanamine hippurate tablets
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: None
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline injection
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Neomycin and Polymyxin B sulfates GU irrigant, Neomycin and Polymyxin B sulfates and Dexamethasone ophthalmic ointment, Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal, antiparasitic, and antiviral drugs in continued reduced supply:
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets and suspension
      • Antiparasitic drugs: Chloroquine tablets, Hydroxychloroquine tablets, Pentamidine isethionate
      • Antiviral drugs: Cidofovir injection
    • Vaccines in coninued reduced supply:
      • Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), Yellow Fever vaccine (YF-VAX is unavailable, but Stamaril can be obtained through a limited number of clinics in the US. Click here).
  • Antimicrobial drugs newly discontinued: 
    • Recent discontinuations: Bacitracin inection (in February 2020), Interferon alfa-2b (Intron A, in October 2019), Quinidine gluconate IV (in December 2017), Terbinafine granules (in May 2017), MenHibrix (in February 2017), Elvitegravir (Vitekta, in December 2016), Peginterferon alfa-2b (in February 2016; 50 mcg vials still available in limited quantities), Boceprevir (in December 2015), Permethrin 1% topical lotion (in September 2015).
April 24, 2020

Sanford Guide Integrates with DoseMeRx


 
Sperryville, VA
April 21, 2020
 
Sanford Guide and Tabula Rasa HealthCare (TRHC), a healthcare technology company advancing the field of medication safety, today announced a collaboration to make Sanford Guide easily accessible from within DoseMeRx™, TRHC’s precision dosing solution.
 
The agreement includes the addition of links to Sanford Guide’s clinically relevant anti-infective drug information and guidelines for the treatment of infectious diseases. Sanford Guide Web Edition and Sanford Guide All Access customers can now seamlessly access their subscription-based resources directly from within DoseMeRx, reducing the time needed to evaluate treatment considerations.
 
“Sanford Guide’s mission is to provide clinically actionable guidelines to providers in the most convenient way possible,” said Sanford Guide’s Vice President, Scott Kelly. “Our collaboration with Tabula Rasa HealthCare and DoseMeRx helps us achieve this by providing pertinent Sanford Guide content with a single click. We’re excited to add this time-saving feature for our mutual clients.”
 
Trusted by clinicians in more than 100 countries, Sanford Guide helps to minimize time-to-answer while providing comprehensive guidance at the point of care. Edited by distinguished infectious disease experts from leading academic and clinical centers, Sanford Guide content provides comprehensive coverage of treatment options for infectious disease, syndromes, and pathogens.
 
“Our goal is to improve patient outcomes while minimizing technology burdens on providers,” said TRHC Chairman and CEO Calvin H. Knowlton, PhD. “By making Sanford Guide available through DoseMeRx, we reduce the workload for pharmacy in healthcare organizations across the country.”
 
According to TRHC Executive Vice President for DoseMeRx, Charles Cornish, “The addition of Sanford Guide will save mutual clients using DoseMeRx crucial time in accessing the latest, updated quality clinical resources needed to enhance patient care.”

 

April 14, 2020

April ID Update

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal. If you received this message from a colleague, subscribe now.
 

APRIL 2020

2020 Sanford Guide Print Editions Now Available

SARS-CoV-2 / COVID-19

Other New or Updated Treatment Guidelines

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of April 8, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since March 20]: Doxycycline injection, Tobramycin lyophilized powder for injection
    • [Shortage recently resolved]: Acyclovir injection, Dalfopristin-Quinupristin injection, Daptomycin injection, Erythromycin lactobionate injection
    • [Continue to be in reduced supply]
      • Aminoglycosides: Amikacin injection, Gentamicin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Benzylpenicilloyl polylysine (Pre-Pen)
      • Carbapenems: Meropenem injection
      • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Apollo Pharmaceuticals and its distributor FFF Enterprises. Click here for details), Cefoxitin injection, Ceftazidime injection, Ceftazidime/avibactam injection, Cefuroxime injection
      • Clindamycin injection
      • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides: Vancomycin injection
      • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable)
      • Methanamine hippurate tablets
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: None
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: None
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Neomycin and Polymyxin B sulfates GU irrigant, Neomycin and Polymyxin B sulfates and Dexamethasone ophthalmic ointment, Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets and suspension
      • Antiparasitic drugs: Chloroquine tablets, Hydroxychloroquine tablets, Pentamidine isethionate
      • Antiretroviral drugs: None
      • Antiviral drugs: Cidofovir injection
      • Vaccines: Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), Yellow Fever vaccine (YF-VAX is unavailable, but Stamaril can be obtained through a limited number of clinics in the US. Click here).
  • Antimicrobial drugs newly discontinued: 
    • Recent discontinuations: Bacitracin inection (in February 2020), Interferon alfa-2b (Intron A, in October 2019), Quinidine gluconate IV (in December 2017), Terbinafine granules (in May 2017), MenHibrix (in February 2017), Elvitegravir (Vitekta, in December 2016), Peginterferon alfa-2b (in February 2016; 50 mcg vials still available in limited quantities), Boceprevir (in December 2015), Permethrin 1% topical lotion (in September 2015).
March 24, 2020

March 24 ID Update

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal. If you received this message from a colleague, subscribe now.
 

MARCH 24, 2020

 

SARS-CoV-2 / COVID-19

  • Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic. Click the link above.
  • We advocate STAY AT HOME except for essential activities, e.g., food, medicines, healthcare and essential work such as police, fire, sanitation and healthcare.
  • AVOID CROWDS  AND/OR CONGESTED AREAS. AVOID COMPLACENCY!

2020 Sanford Guides

  • We anticipate that 2020 print editions of The Sanford Guide to Antimicrobial Therapy will become available in the coming weeks. To receive a notice as soon as the books are released, sign up here.

New or Updated Treatment Guidelines

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of March 20, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since February 8]: Benzylpenicilloyl polylysine (Pre-Pen), Ceftazidime/avibactam, Chloroquine tablets, Gemifloxacin tablets, Gentamicin injection, Hydroxychloroquine tablets, Methenamine hippurate tablets, Neomycin and Polymyxin B sulfates and Dexamethasone ophthalmic ointment
    • [Shortage recently resolved]: Erythromycin 0.5% ophthalmic ointment, Metronidazole injection, Tuberculin (PPD)
    • [Continue to be in reduced supply]
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Carbapenems: Meropenem injection
      • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Apollo Pharmaceuticals and its distributor FFF Enterprises. Click here for details), Cefoxitin injection, Ceftazidime injection, Cefuroxime injection
      • Clindamycin injection
      • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides: Daptomycin injection, Vancomycin injection
      • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: None
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: None
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Neomycin and Polymyxin B sulfates GU irrigant, Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets and suspension
      • Antiparasitic drugs: Pentamidine isethionate
      • Antiretroviral drugs: None
      • Antiviral drugs: Acyclovir injection, Cidofovir injection
      • Vaccines: Hepatitis B vaccine recombinant, Zoster vaccine recombinant (Shingrix), Yellow Fever vaccine (YF-VAX is unavailable, but Stamaril can be obtained through a limited number of clinics in the US. Click here).
  • Antimicrobial drugs newly discontinued: 
    • Recent discontinuations: Bacitracin inection (in February 2020), Interferon alfa-2b (Intron A, in October 2019), Quinidine gluconate IV (in December 2017), Terbinafine granules (in May 2017), MenHibrix (in February 2017), Elvitegravir (Vitekta, in December 2016), Peginterferon alfa-2b (in February 2016; 50 mcg vials still available in limited quantities), Boceprevir (in December 2015), Permethrin 1% topical lotion (in September 2015).