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.
 

August 2019

From CDC

• Updated recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) regarding prevention of Japanese encephalitis (JE) among US travelers and laboratory workers (MMWR Recomm Rep 2019;68(No. RR-2):1-33). The report summarizes the epidemiology of JE, describes the JE vaccine that is licensed and available in the US, and provides recommendations for its use. These recommendations update the 2010 release and are available on the CDC website.

Practice Pearls

• Sofosbuvir/velpatasvir (Epclusa) is a pangenotypic, fixed-dose combination of sofosbuvir (NS5B RNA polymerase inhibitor) and velpatasvir (NS5A inhibitor) used for the treatment of chronic HCV. Velpatasvir is a lipophilic weak base with pH-dependent solubility (its solubility decreases as pH increases). Therefore, drugs like proton-pump inhibitors (PPI) impair velpatasvir absorption by raising gastric pH, and coadministration of sofosbuvir/velpatasvir with PPIs is generally not recommended. If it is medically necessary, the manufacturer recommends that sofosbuvir/velpatasvir be administered with food and taken four hours before omeprazole (20 mg). In a recent open-label, randomized, 3-arm crossover study, 11 healthy volunteers were administered a single dose of sofosbuvir/velpatasvir a) alone, b) with omeprazole (at steady-state concentrations), or c) with omeprazole combined with 250 mL of Coca-Cola. Pharmacokinetic sampling was performed on days 5-7 of each arm (see chart below). The data suggest that taking sofosbuvir/velpatasvir with Coca-Cola can overcome the interaction with proton-pump inhibitors, presumably by temporarily lowering gastric pH and thus enhancing velpatasvir solubility and absorption (Clin Pharmacol Ther 2019 Jul 17 [Epub ahead of print]).
  

  Study arm (seven days per arm, 7 days washout between arms)	Velpatasvir AUC (geometric mean)
  Sofosbuvir/velpatasvir 400/100 mg on day 5 + 250 mL water	3742 mcg*hr/L
  Sofosbuvir/velpastavir 400/100 mg on day 5 + 250 mL water, omeprazole 40 mg qd (days 1-6)	2705 mcg*hr/L
  Sofosbuvir/velpastavir 400/100 mg on day 5 + 250 mL Coca-Cola, omeprazole 40 mg qd (days 1-6)	5981 mcg*hr/L

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of August 1, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since July 17]: Bacitracin ophthalmic ointment, Griseofulvin oral tablets, Letermovir tablets
  • [Shortage recently resolved]: Amphotericin B injection, Nelfinavir tablets, Valganciclovir oral powder for solution
  • [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 (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Clindamycin injection
    • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection, Erythromycin 0.5% ophthalmic ointment
    • Nitrofurantoin oral suspension
    • Nitroimidazoles: Metronidazole injection
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Tetracyclines: Doxycycline hyclate injection
    • Topical (miscellaneous) antibacterials: Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Nystatin oral suspension
    • Antiparasitic drugs: Pentamidine isethionate
    • Antiretroviral drugs: None
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection (unavailable)
    • Vaccines: Hepatitis A vaccine inactivated, 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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)
• For detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages

 
Sperryville, VA – Sanford Guide® announces the availability of its industry-leading infectious diseases guidelines through MD Labs® Results Reports. This new integration, facilitated by Sanford Guide’s content delivery API, links to pertinent Sanford Guide content directly from the report to help guide appropriate antimicrobial selection and dosing. “Interpreting lab results within the context of a given therapeutic scenario can be a challenge. Pairing Sanford Guide content with MD Labs’ succinct reports in an interactive and continuously updated format will help clinicians make the right decisions for their patients,” noted Sanford Guide vice president Scott Kelly.
 
MD Labs, an industry leader in clinical diagnostic testing and reporting, delivers Results Reports with interactive Sanford Guide content through its online client portal. Providing services in the areas of clinical toxicology, pharmacogenetics, and molecular diagnostics, MD Labs was founded with the goal of creating a more provider-friendly testing service that prides itself on delivering prompt, accurate, reliable, and easy to understand results. Integration of Sanford Guide content into Results Reports furthers this mission by providing clinicians with actionable guidance on how to act upon test results.
 
Since releasing its content delivery API in 2017, Sanford Guide content has been made available to tens of thousands of practitioners directly within their clinical surveillance and laboratory information systems. Providing information that is accessible, concise, and reliable, Sanford Guide’s API saves valuable time by providing information that is integrated seamlessly within the clinical workflow. The API furthers Sanford Guide’s mission by reducing time-to-answer and providing guidance when it is needed most.
 
About MD Labs
MD Labs was founded in 2011 with the goal bringing new technologies to the laboratory space and serving physicians across the United States. Constantly adding services based on new technologies, Physician requests and pharmacotherapeutic trends allows us to provide quick, accurate, and cost-effective labwork while enhancing overall patient care.
 
About Sanford Guide
Since 1969, Sanford Guide has been a leader in point-of-care recommendations for the treatment of infectious diseases. Widely used by pharmacists, physicians, physician assistants, and nurses, Sanford Guide helps to improve patient care by providing carefully curated recommendations based on the latest evidence. Sanford Guide takes pride in responsiveness to customers, the development of innovative solutions, and providing content that is unparalleled in quality and clinical applicability.
 

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.
 

July 2019

New Antimicrobial Drug Approvals

• Recarbrio (imipenem/cilastatin/relebactam), approved for patients ≥18 years of age who have limited or no alternative treatment options for complicated urinary tract infections (including pyelonephritis) and complicated intra-abdominal infections. Imipenem is a carbapenem, cilastatin is an inhibitor of renal dehydropeptidase, and relebactam is a beta-lactamase inhibitor. Recommended dosage, normal renal function: 1.25 gm (imipenem 500 mg, cilastatin 500 mg, relebactam 250 mg) IV q6h. Note that the cilastatin is included in the dosage of this product, unlike imipenem/cilastatin.

New or Updated Treatment Guidelines

• Clinical practice guidelines for the management of chronic hepatitis B, from the Korean Association for the Study of the Liver (KASL) (Clin Mol Hepatol 25:93, 2019). These guidelines update the 2015 release and are available on the journal website.

• 2019 European guidelines for the management of lymphogranuloma venereum, from the International Union against Sexually Transmitted Infections (J Eur Acad Dermatol Venereol 2019 June 26 [Epub ahead of print[). These guidelines update the 2013 release and are available on the journal website.

Practice Pearls

• We would not expect drug-drug interactions to be a significant issue with clotrimazole troches, given the poor oral absorption of clotrimazole from that formulation. However, a heart transplant patient receiving everolimus (a CYP3A4 and P-glycoprotein substrate) for rejection prevention and clotrimazole troches 10 mg qid for thrush prophylaxis experienced a sharp drop in everolimus trough concentrations (8.4 to 2.5 ng/mL) following the discontinuation of clotrimazole (calculated oral clearance of everolimus increased from 6.0 to 11.2 L/hr). A similar phenomenon has been observed in patients treated with tacrolimus (also a CYP3A4 and P-gp substrate) and clotrimazole troches, and it may have contributed to graft rejection. In another study, clotrimazole troches reduced the oral clearance of midazolam (a CYP3A4 substrate) without affecting systemic clearance. A plausible explanation is that clotrimazole achieves sufficient intestinal concentrations to inhibit presystemic clearance and thus enhance everolimus bioavailability (by inhibiting intestinal CYP3A4 and/or P-gp), but it achieves insufficient concentrations in the hepatic circulation to inhibit hepatic CYP3A4 and/or P-gp (Br J Clin Pharmacol 2019 June 26 [Epub ahead of print]).

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of July 1, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since June 11]: None
  • [Shortage recently resolved]: Amphotericin B injection, Nelfinavir tablets
  • [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 (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable), Erythromycin 0.5% ophthalmic ointment
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Tetracyclines: Doxycycline hyclate injection
    • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension, Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Nystatin oral suspension
    • Antiparasitic drugs: Pentamidine isethionate
    • Antiretroviral drugs: None
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection (unavailable), Valganciclovir oral powder for solution
    • Vaccines: Hepatitis A vaccine inactivated, 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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)
• For detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages

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 2019

CDC Health Advisory

• CDC is expecting a 3 to 10 month nationwide shortage of Aplisol (Par Pharmaceuticals), one of two purified-protein derivative (PPD) tuberculin antigens that are licensed by the US FDA for use in performing tuberculin skin tests (TSTs). The time frame is the manufacturer's current estimate and is subject to change. Suggested approaches for dealing with the shortage include substituting IGRA blood tests for TSTs, using the other licensed product (Tubersol), and prioritizing allocation of TSTs in consultation with state and local public health authorities. Further information can be found on the CDC website.

Practice Pearls

• Kounis syndrome, first described in 1991, is an unusual hypersensitivity reaction to various allergens, including drugs, that results in vasospasm of the coronary arteries. It is also known as allergic angina or allergic MI. There are three types. In type I, patients have normal coronary arteries, no predisposing factors, and no elevation in cardiac enzymes. Type II occurs in patients with inactive underlying coronary artery disease in whom the allergic episode results in vasospasm without cardiac enzyme elevation. Type III includes coronary artery stent thrombosis secondary to the allergic episode. Kounis syndrome manifests with signs and symptoms of myocardial ischemia and is potentially life-threatening if not recognized promptly. Treatment begins with discontinuation of the causative agent, but there is no consensus as to the value of administering drugs that dilate the coronary arteries or suppress the allergic response. Many case reports of Kounis syndrome associated with beta-lactams, most commonlyamoxicillin, have been published. A recent report describing type I Kounis syndrome in a patient receiving a preoperative dose of vancomycin for surgical management of a gangrenous toe is only the second to implicate that drug (Am J Emerg Med 2019 June 3 [Epub ahead of print]).

New or Updated Treatment Guidelines

• Guidelines for the diagnosis and management of CMV infection in patients following hematopoietic stem-cell transplantation and in patients receiving other types of therapy for hematological malignancies, from the 2017 European Conference on Infectious in Leukemia (ECIL 7) (Lancet Infect Dis 2019 May 29 [Epub ahead of print]).
• 2019 guidelines for the management of tuberculosis in adults living with HIV, from the British HIV Association (HIV Med 20 Suppl 6: s2-s83, 2019). These guidelines update the 2011 version and are available on the journal website.
• Guidelines from the French scientific societies for the biological diagnosis, treatment, persistent symptoms after documented or suspected Lyme borreliosis (Med Mal Infect 2019 May 30 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention and management of varicella zoster virus (VZV) in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 June 4 [Epub ahead of print]).
• Updated guidelines for the diagnosis and management of Candida infections in solid organ transplant recipients, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 June 2 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 30 [Epub ahead of print]).
• Updated guidelines for the epidemiology, diagnosis, prevention and management of methicillin-resistant Staphylococcus aureus (MRSA) infections in solid organ transplantation, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 23 [Epub ahead of print]).
• Updated guidelines for the management of intra-abdominal infections in solid organ transplant recipients, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 18 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of infections due to multidrug-resistant (MDR) Gram-negative bacilli in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 18 [Epub ahead of print]).
• Updated guidelines for the epidemiology and management of human papillomavirus (HPV) infections in solid organ transplant recipients, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 11 [Epub ahead of print]).
• Updated guidelines for the epidemiology, diagnosis, prevention and management of nontuberculous mycobacterial infections in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 11 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention and management of Pneumocystis jiroveci fungal infection in solid organ transplant recipients, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 11 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention, and management of post-operative surgical site infectionsin solid organ transplantation, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 May 11 [Epub ahead of print]).

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of June 11, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since May 4]: Sulfanilamide 15% vaginal cream 
  • [Shortage recently resolved]: Amphotericin B injection, Nelfinavir tablets
  • [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 (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable), Erythromycin 0.5% ophthalmic ointment
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Tetracyclines: Doxycycline hyclate injection
    • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
    • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Nystatin oral suspension
    • Antiparasitic drugs: Pentamidine isethionate
    • Antiretroviral drugs: None
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection (unavailable), Valganciclovir oral powder for solution
    • Vaccines: Hepatitis A vaccine inactivated, 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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)
• For detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages

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 2019
 

New Print Editions Now Available

• Sanford Guide's 2019 print editions are now available for immediate shipping. New this year is a spiral-bound edition combining HIV/AIDS Therapy and Hepatitis Therapy.

New Drug Approvals

• Avaclyr (acyclovir* 3% ophthalmic ointment), approved for the treatment of acute herpetic keratitis (dendritic ulcers) in patients with HSV-1 and HSV-2. Recommended dosage: one ribbon of ointment in the lower cul-de-sac of the affected eye 5 times a day until ulcer has healed, then 3 times daily for 7 days. Product availability: 3.5 gm tubes.
• Dengvaxia (Dengue Tetravalent Vaccine, Live), approved by the US FDA for the prevention of dengue disease caused by all dengue virus serotypes (1, 2, 3, and 4). There are major restrictions: the vaccine is approved only for use in individuals age 9-16 with laboratory-confirmed previous dengue infection and living in endemic areas. It is a live, attenuated vaccine that is administered as three separate injections six months apart. The vaccine has already been approved in 19 countries and the European Union.
• Tolsura (itraconazole*), approved for the treatment of blastomycosis (pulmonary and extrapulmonary), histoplasmosis (including chronic cavitary pulmonary disease and disseminated, non-meningeal histoplasmosis), and aspergillosis (pulmonary and extrapulmonary) in patients who are intolerant of or who are refractory to amphotericin B*. This product is a new formulation with improved bioavailability. Availability: 65 mg capsules.

Updated Pediatric HIV Guidelines

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

New or Updated Treatment Guidelines

• Updated guidelines for the epidemiology, diagnosis, prevention, and management of infection due to Arenaviruses and West Nile Virus (WNV) in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 25 [Epub ahead of print]).
• Updated guidelines for the diagnosis, prevention and management of Human T-cell lymphotrophic virus 1 (HTLV)-1 in the pre- and post-transplant period, from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 25 [Epub ahead of print]).
• Updated guidelines for the prevention and management of Clostridium difficile infection in solid organ transplant (SOT) recipients from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 19 [Epub ahead of print]).
• Updated guidelines for the vaccination of solid organ transplant candidates and recipients from the Infectious Diseases Community of Practice of the American Society of Transplantation (Clin Transplant 2019 Apr 19 [Epub ahead of print]).

Practice Pearls

• Eculizumab is a monoclonal antibody that binds to complement protein C5, inhibiting its cleavage to C5a and C5b and thereby inhibiting deployment of the terminal complement system. It is indicated for paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome, and anti-acetylcholine receptor antibody-positive generalized myasthenia gravis. Unfortunately, complement blockade at C5 interferes with the immune system’s ability to respond effectively to Neisseria infection. Therapy with eculizumab is thought to increase the risk of meningococcal disease 1000- to 2000-fold. The product labeling includes a black box warning about life-threatening and fatal infection due to N. meningitidis*, but infection due to other Neisseria species is less well characterized. The first case series of N. gonorrhoeae* infections in patients receiving eculizumab was recently published. Eight of nine cases of N. gonorrhoeae infection identified by an FDA spontaneous safety report search were disseminated gonococcal infection (DGI). All eight DGI patients were hospitalized, seven were bacteremic, and two required pressor support (one of whom also required mechanical ventilation). The limited data suggest that patients treated with eculizumab may be at higher risk of DGI than the general population (Clin Infect Dis 2018 Nov 12 [Epub ahead of print]).

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of May 4, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since April 21]: Doxycycline injection
  • [Shortage recently resolved]: Ciprofloxacin injection
  • [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 (unavailable), Cefoxitin injection, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
    • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
    • Glyco-, glycolipo-, lipopeptides: Daptomycin injection, Vancomycin injection
    • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable), Erythromycin 0.5% ophthalmic ointment
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
    • Antifungal drugs: Amphotericin B injection (unavailable), Clotrimazole 10 mg oral troches, Fluconazole injection, Nystatin oral suspension (unavailable)
    • Antiparasitic drugs: Pentamidine isethionate
    • Antiretroviral drugs: Nelfinavir tablets
    • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection (unavailable), Valganciclovir oral powder for solution
    • Vaccines: Hepatitis A virus vaccine inactivated, 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: Quinidine gluconate IV (in December 2017). Product distribution will continue until expiration of current stock (March 2019).
  • Recent discontinuations: 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)
• For detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages