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 2020

Given the current SARS-CoV-2 situation, Sanford Guide is releasing this special ID Update with the latest information. A more comprehensive ID Update will be released later this month.
 

SARS-CoV-2*

• CDC Health Alert Network (HAN) No. 428: Update and Interim Guidance on Outbreak of Coronavirus Disease 2019 (COVID-19). This is classified as a Health Update and is available on the CDC website.
• Insights and concise update of current situation: JAMA 2020 Feb 28 [Epub ahead of print].
• Detailed clinical and epidemiologic description of the first 425 cases reported in Wuhan (N Engl J Med 2020 Jan 29 [Epub ahead of print]) with an associated editorial from Fauci et al (N Engl J Med 2020 Feb 28 [Epub ahead of print]).
• Perspective from Bill Gates: N Engl J Med 2020 Feb 28 [Epub ahead of print].

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.
 

FEBRUARY 2020

SARS-CoV-2

• WHO officially names the virus 2019-nCoV as SARS-CoV-2*. The disease caused by the virus is named COVID-19.
• Rapid advice guideline for the diagnosis and treatment of 2019-nCoV pneumonia, prepared in accordance with the methodology and general rules of WHO Guideline Development and the WHO Rapid Advice Guidelines (Mil Med Res 2020;7:4). The guidelines are available on the journal website.

New or Updated Treatment Guidelines

• Clinical practice guidelines for the prevention and management of viral hepatitis in inflammatory bowel disease, from the Korean Association for the Study of Intestinal Diseases (Intest Res 2020;18:18). The guidelines are available on the journal website.
• S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia (J Dtsch Dermatol Ges 2020;18:55). These guidelines were developed on behalf of the German Herpes Management Forum under the auspices of the Paul Ehrlich Society of Chemotherapy.
• Surviving Sepsis Campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children, from the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med 2020;21:e52). The guidelines are available on the journal website.
• Clinical practice guidelines for the management of vascular graft and stent graft infections, from the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg 2020 Jan 30 [Epub ahead of print]).

From CDC

• At its October 2019 meeting, the Advisory Committee on Immunization Practices (ACIP) voted to approve the 2020 Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, and the 2020 Recommended U.S. Adult Immunization Schedule for Persons Aged 19 Years and Older. Tables and accompanying notes can be found on the CDC website.
• Guidelines for the treatment of latent tuberculosis infection, from the National Tuberculosis Controllers Association and CDC (MMWR Recomm Rep 2020;69(No. RR-1):1–11). The guidelines are available on the CDC website.

From FDA

• The US FDA has requested that all current manufacturers of bacitracin for injection voluntarily withdraw their product from the market. Based on FDA’s review of currently available data, FDA believes that the potential problems associated with bacitracin for injection are sufficiently serious to remove the drug from the market. This requested voluntary withdrawal does not impact approved topical or ophthalmic drugs that contain bacitracin. More information can be found here.

Drug Shortages (US)

• Antimicrobial drugs or vaccines in reduced supply or unavailable (as of February 8, 2020) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • [New on the list since January 5]: Erythromycin 0.5% ophthalmic ointment
  • [Shortage recently resolved]: Doxycycline hyclate injection, 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 (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: Metronidazole injection
    • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
    • Tetracyclines: None
    • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment (unavailable), Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Neomycin and Polymyxin B sulfates GU irrigant, 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).

• For detailed information including estimated resupply dates, see https://www.ashp.org/Drug-Shortages/

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 guidelines for the diagnosis (Pediatr Infect Dis J 2019;38(12S Suppl):S3), treatment (Pediatr Infect Dis J 2019;38(12S Suppl):S10), and prevention (Pediatr Infect Dis J 2019;38(12S Suppl):S22) of acute otitis media, from the Italian Society of Pediatrics. These guidelines update the 2010 release and are all available on the journal website.

• 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).

• For detailed information including estimated resupply dates, see https://www.ashp.org/Drug-Shortages/

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.

• Clinical practice guidelines for the diagnosis and management of human herpesvirus (HHV)-6B encephalitis after allogeneic hematopoietic stem cell transplantation, from the Japan Society for Hematopoietic Cell Transplantation (Bone Marrow Transplant 2019 Nov 19 [Epub ahead of print]).

• 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).

• 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.
 

NOVEMBER 2019

New or Updated Treatment Guidelines

• Updated Swedish guidelines for the management of hepatitis B virus infection, from the Swedish Reference Group for Antiviral Therapy (Infect Dis Lond 2019 Oct 15 [Epub ahead of print]). These guidelines update the 2007 release and are available on the journal website.

• Global guidelines for the diagnosis and management of mucormycosis*, fromthe European Confederation of Medical Mycology (ECMM) in cooperation with the Mycoses Study Group Education and Research Consortium (Lancet Infect Dis 2019 Nov 4 [Epub ahead of print]).

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