News

News

January 24, 2020

January 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.
 

JANUARY 2020

New or Updated Treatment Guidelines

  • Updated HHS panel Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. The guidelines are available on the AIDSinfo website.
  • Updated HHS Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the US. The guidelines are available on the AIDSinfo website.
  • Prevention and Treatment of Cancer-Related Infections, version 1.2020, from the National Comprehensive Cancer Network (NCCN). The guidelines are available on the NCCN website.

From CDC

  • Revised recommendations for the use of anthrax vaccine in the United States, from the CDC Advisory Committee on Immunization Practices (MMWR Recomm Rep 2019;68(RR-4):1-14). These recommendations update the 2009 release and are available on the CDC website.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of January 5, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since December 9]: Neomycin and Polymyxin B sulfates GU irrigant
    • [Shortage recently resolved]: Letermovir injection, Rabies immune globulin, Rabies vaccine
    • [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, 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: Metronidazole injection
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline hyclate injection
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment, 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: 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).
December 11, 2019

December 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.
 

DECEMBER 2019

Sanford Guide Releases New Apps

  • Sanford Guide recently upgraded its systems to support a new generation of mobile apps. Users of the Sanford Guide Collection app will see many improvements immediately, while users of other Sanford Guide apps will see new features become available in the next few months. Among the new features now available to Collection users:
    • Clean and modern look and feel with intuitive user interface and improved visual cues to accelerate navigation.
    • Cloud-based bookmarks and notes are shared between platforms (create a bookmark on one device and it will appear automatically on your other devices).
    • The Spectra of Activity is faster on most devices, and when examining an interaction by tapping on it, Stewardship Assist users can choose to filter down to only the active data set or to view all data sets at once.
    • Stewardship Assist users can now access institutional data by tapping their hospital's logo on the home screen.

New Parenteral Cephalosporin

  • The US FDA has approved cefiderocol* (Fetroja) for the treatment of adults with complicated UTI, including pyelonephritis*, caused by susceptible strains of E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa, and E. cloacae complex. Cefiderocol functions as a siderophore, chelating ferric ions and taking advantage of the bacterial iron transport system for enhanced accumulation in the bacterial periplasmic space. The drug should be reserved for use in patients with limited or no alternative treatment options. Recommended dosage: 2 gm IV (infused over 3 hours) q8h x7-14 days.

New or Updated Treatment Guidelines

  • New clinical practice guidelines for the management of drug-resistant tuberculosis, from the American Thoracic Society, European Respiratory Society, Infectious Diseases Society of America, and Centers for Disease Control (Am J Respir Crit Care Med 2019;200:e93-e142). The guidelines are available on the journal website.
  • Guidelines for the diagnosis, treatment, and prevention of disseminated Mycobacterium chimaera infection following cardiac surgery with cardiopulmonary bypass, from the International Society of Cardiovascular Infectious Diseases (J Hosp Infect 2019 Nov 9 [Epub ahead of print]). The guidelines are available on the journal website.
  • In the recently published Committee Opinion (No. 782) on prevention of early-onset group B streptococcal disease in infants, the American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal-rectal cultures at 36 0/7-37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes (Obstet Gynecol 2019;134:e19). This Committee Opinion serves as an update to and replacement of the obstetric components of CDC's 2010 GBS guidelines and is available on the ACOG website.

From CDC

  • The newly released Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report) is intended to serve as a reference for information on antibiotic resistance, provide the latest US antibiotic resistance burden estimates for human health, and highlight emerging areas of concern and additional action needed. The report divides 18 antibiotic-resistant bacteria and fungi into three categories based on level of concern to human health (urgent, serious, and concerning). Like the first AR Threat Report published in 2013, the 2019 report does not include viruses or parasites. It is available on the CDC website.
  • Guidance for using tafenoquine* for prevention and antirelapse therapy for malaria (MMWR Morb Mortal Wkly Rep 2019;68:1062). If G6PD status is unknown, quantitative G6PD testing must be performed to confirm normal activity before tafenoquine is used. See report for more details.
  • CDC maintains a list of multistate foodborne outbreak investigations since 2006 in which CDC was the lead public agency. Of recent interest are 1) 67 people from 19 states infected with E. coli O157:H7 linked to romaine lettuce harvested from the Salinas, California growing region, 2) 21 people from 13 states infected with Salmonella (serovar Oranienburg), likely due to contact with pet turtles (turtles carry Salmonella in their droppings), and 3) 241 people from 11 states with laboratory-confirmed Cyclospora infection, probably resulting from exposure (which occurred in five states) to fresh basil imported from Mexico. The Cyclospora outbreak appears to be over.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of December 9, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since November 8]: Erythromycin lactobionate injection, Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment
    • [Shortage recently resolved]: Ceftriaxone injection, Ciprofloxacin oral suspension, Erythromycin 0.5% ophthalmic ointment, Nystatin oral suspension
    • [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, 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)
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: Metronidazole injection
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline hyclate injection
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal 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, Letermovir injection (unavailable)
      • Vaccines: Hepatitis B vaccine recombinant, Rabies vaccine (and immune globulin), 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: 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).
November 15, 2019

November 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.
 

NOVEMBER 2019

New or Updated Treatment Guidelines

New for H. pylori Treatment

  • The US FDA has approved the three-drug combination of rifabutin, amoxicillin, and omeprazole (Talicia*) for the treatment of Helicobacter pylori* infection in adults. Each capsule contains rifabutin 12.5 mg (immediate-release), amoxicillin 250 mg (immediate-release), and omeprazole 10 mg (delayed-release). Recommended dosage is four capsules q8h for 14 days, with food. US product launch is expected in the first quarter of 2020.

Intron A Discontinued

  • Based on an evaluation of clinical use and the availability of alternative therapies, Merck is discontinuing recombinant interferon alfa-2b (Intron A), in all strengths. Supply availability should continue over the next 1-2 years depending on product formulation and dose strength.

CABP Indication for Delafloxacin

  • Delafloxacin* is now indicated in adults for the treatment of community-acquired bacterial pneumonia due to S. pneumoniae, MSSA, K. pneumoniae, E. coli, P. aeruginosa, H. influenzae, H. parainfluenzae, C. pneumoniae, L. pneumophila, and M. pneumoniae. This is the drug's second FDA-approved indication.

Baloxavir Indication Expanded to High-Risk Patients

  • Baloxavir* is now indicated for the treatment of acute uncomplicated influenza in patients 12 years of age and older who have been symptomatic for ≤48 hours and are 1) otherwise healthy, or 2) at high risk of developing influenza-related complications. High risk factors include underlying asthma or chronic lung disease, diabetes, heart disease, morbid obesity, and age ≥65 years.

Second Drug Approved for PrEP

  • Descovy (emtricitabine 200 mg + TAF 25 mg) is the second drug to be approved by the US FDA for HIV-1 pre-exposure prophylaxis (PrEP)*. It is indicated in at-risk adults and adolescents weighing at least 35 kg to reduce the risk of HIV-1 infection from sexual acquisition, excluding individuals at risk from receptive vaginal sex. Individuals must be screened for HIV-1 infection immediately prior to starting PrEP, and then at least once every three months. The recommended dosage is one tablet orally once daily, with or without food. The first drug to be approved for PrEP was Truvada (emtricitabine 200 mg + TDF 300 mg) in 2012.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of November 8, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since October 17]: None
    • [Shortage recently resolved]: Erythromycin lactobionate 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
      • Clindamycin injection
      • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides: Daptomycin injection, Vancomycin injection
      • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), 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: Bacitracin ophthalmic ointment (unavailable), Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets and suspension, Nystatin oral suspension
      • Antiparasitic drugs: Pentamidine isethionate
      • Antiretroviral drugs: None
      • Antiviral drugs: Acyclovir injection, Cidofovir injection, Letermovir injection (unavailable)
      • Vaccines: Hepatitis B vaccine recombinant, Rabies vaccine (and immune globulin), 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: 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).
  • For detailed information including estimated resupply dates, see http://www.ashp.org/menu/DrugShortages
October 8, 2019

October 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.
 

OCTOBER 2019

New or Updated Treatment Guidelines

Improved Access to IV Artesunate

  • IV artesunate* is the first-line, WHO-recommended treatment for severe malaria but is neither FDA-approved nor commercially available in the United States. Obtaining the drug from CDC has been problematic due to limited supply and other issues, but recent efforts have improved drug accessibility for those who need it. As of April 2019, CDC will release artesunate for all cases of severe malaria, any case of malaria where the patient is not tolerating oral medications, or any highly suspected case of severe malaria. The drug is pre-positioned at 18 locations nationally, and the hospital will need to send someone to the receiving airport or quarantine station to retrieve it. Call the CDC Malaria Hotline, (770) 488-7788, Mon-Fri, 9 am to 5 pm US EST. After hours, or on weekends or holidays, call the CDC Emergency Operations Center at (770) 488-7100 and ask to page the person on call for the Malaria Branch.

Practice Pearl

  • DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a T-cell-mediated hypersensitivity reaction characterized by fever, facial edema, maculopapular rash, lymphadenopathy, eosinophilia, mononucleosis-like atypical lymphocytosis, and multiorgan involvement (hepatitis, nephritis, arthritis, pneumonitis, carditis). The latency period is 2-8 weeks, and mortality approaches 10%. Recognized drug triggers include anticonvulsants, allopurinol, and antibiotics, including vancomycin. There are well-known HLA associations with drug hypersensitivity reactions, such as HLA-B*57:01 and hypersensitivity to abacavir; could variation within HLA predispose to vancomycin-associated DRESS? In 23 patients with vancomycin-associated DRESS, 82.6% carried the HLA-A*32:01 allele compared to 0% of 46 matched vancomycin-tolerant control patients (p=1 x 10-8). The patients with vancomycin-associated DRESS were primarily of European ancestry. In a larger cohort of 54,249 patients, the HLA-A*32:01 allele carriage rate was 6.3%, matching the carriage rate in other cohorts of mainly European ancestry. The authors estimate that approximately 75 patients started on vancomycin would need to undergo HLA-A*32:01 testing to prevent one case of vancomycin-associated DRESS. If validated, the association of HLA-A*32:01 carriage with vancomycin-associated DRESS could be useful not only for the prediction and prevention of the hypersensitivity reaction, but also for monitoring and risk stratification (J Allergy Clin Immunol 2019;144:183).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of October 7, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since August 30]: Acyclovir injection, Rabies Immune Globulin, Rabies vaccine
    • [Shortage recently resolved]: Erythromycin lactobionate 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
      • 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 0.5% ophthalmic ointment
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: Metronidazole injection
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline hyclate injection
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment (unavailable), Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets, Nystatin oral suspension
      • Antiparasitic drugs: Pentamidine isethionate
      • Antiretroviral drugs: None
      • Antiviral drugs: Cidofovir injection, Letermovir injection (unavailable)
      • 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: 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)
September 10, 2019

September 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.
 

September 2019

New Antimicrobial Drug Approvals

  • Xenleta (lefamulin*), a systemically-administered pleuromutilin, approved for the treatment of adult with community-acquired pneumonia caused by susceptible strains of S. pneumoniae, MSSA, H. influenzae, L. pneumophila, M. pneumoniae, and C. pneumoniae. Pleuromutilins inhibit bacterial protein synthesis by binding to the peptidyl transferase center of the 50S bacterial ribosome, thereby preventing the binding of tRNA for peptide transfer. Recommended dosage: 150 mg IV q12h x5-7 days (switching to oral therapy to complete the course if appropriate), or 600 mg po q12h x5 days. Product availability: injection, 600 mg tablets.
  • Pretomanid* Tablets, a nitroimidazooxazine antimycobacterial drug, approved as part of a combination regimen with bedaquiline and linezolid for the treatment of adults with pulmonary MDR-TB or XDR-TB. Recommended dosage: 200 mg po once daily for 26 weeks (with bedaquiline and linezolid). The combination regimen should be taken with food. Product availability: 200 mg tablets.

Drug Safety Communications

  • The US FDA has issued a warning about worsening liver function or liver failure occurring in chronic hepatitis C patients with moderate to severe liver impairment who are treated with glecaprevir/pibrentasvir (Mavyret), elbasvir/grazoprevir (Zepatier), or sofosbuvir/velpatasvir/voxilaprevir (Vosevi). All three contain a NS3/4A protease inhibitor (the drug ending in -previr) and are not indicated for use in patients with moderate to severe liver impairment.  In most patients, symptoms resolved or new-onset worsening of liver function improved after stopping treatment. The full Drug Safety Communication can be found here.

From CDC

  • The recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the US for the 2019-2020 season have been released (MMWR Recomm Rep 2019;68(No. RR-3):1–21). U.S. trivalent vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1)pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain HA derived from these three viruses and from an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage). This composition includes updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. The full report is available on the MMWR website.

New or Updated Treatment Guidelines

  • Clinical practice guidelines for microbiological laboratory testing used in the diagnosis of fungal infections commonly encountered in pulmonary and critical care practice, from the American Thoracic Society (Am J Respir Crit Care Med 2019;200:535). The guidelines are available for download on the journal website.
  • Revised guidelines for the management of HHV-6 infections in patients with hematological malignancies and after hematopoietic stem cell transplantation, from the 2017 European Conference on Infectious in Leukemia (Haematologica 2019 August 29 [Epub ahead of print]). The guidelines are available for download on the journal website.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of August 30, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since August 1]: None
    • [Shortage recently resolved]: Hepatitis A vaccine inactivated, Letermovir 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
      • 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: Bacitracin ophthalmic ointment (unavailable), Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets, Nystatin oral suspension
      • Antiparasitic drugs: Pentamidine isethionate
      • Antiretroviral drugs: None
      • Antiviral drugs: Cidofovir injection, Letermovir injection (unavailable)
      • 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: 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)