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Sept '22 Infectious Disease Update

Sep 13th 2022

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. To sign up for ID updates to your inbox, register here.



Sanford Guide SARS-CoV-2 / COVID-19 material is freely available to all for the course of the pandemic.

  • September 11: We have completely reworked our COVID-19 vaccines page for the new bivalent vaccines. Check it out!
  • August 31: The US FDA amends the EUAs of the Moderna and Pfizer-BioNTech vaccines to authorize bivalent formulations for use as a single booster dose at least two months following primary or booster vaccination. The bivalent vaccines contain two mRNA components of SARS-CoV-2 virus: one of the original strain of SARS-CoV-2, and the other one in common between the BA.4 and BA.5 lineages of the omicron variant.

    The Moderna COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals ≥18 years of age. The Pfizer-BioNTech COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals ≥12 years of age.

  • COVID-19 vaccination in cancer patients: preliminary recommendations from NCCN here.
  • Currently authorized vaccines. See COVID-19 Prevention for table summarizing use and data.
  • ESCMID COVID-19 living guidelines: drug treatment and clinical management (Clin Microbiol Infect 2022;28:222). Available at PMC.
  • Guidelines on COVID-19 diagnosis, serology, treatment and management, and infection prevention: IDSA and NIH.
  • Living WHO guideline on drugs for COVID-19 (BMJ 2021;375:n2936).
  • Living WHO guideline on drugs to prevent COVID-19 (BMJ 2021;372:n526). Available here.
  • Living WHO guideline on prophylaxis against COVID-19 (BMJ 2021;373:n949). Available at PMC.
  • Management of hospitalized adults with COVID-19: a European Respiratory Society living guideline (Eur Respir J 2021;57(4):2100048). Available at PMC.

2022-2023 Influenza Vaccination

  • Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2022–23 influenza season (MMWR Recomm Rep 2022;71(No. RR-1):1–28). PDF available here.

Polio Vaccination

  • In June 2022, poliovirus* was confirmed in an unvaccinated immunocompetent adult resident of Rockland County, New York. Vaccine-derived poliovirus type 2 was isolated from the patient and also identified from wastewater samples in two neighboring New York counties. Here are the current recommendations for children who were not vaccinated per the routine schedule, and adults who have had less than 3 doses.
    • Primary schedule, routine, age 6 weeks through 17 years: IPV at ages 2, 4, and 6-18 months.
    • Catch-up schedule if not initiated at normal age: 0, 1, and 2 months if age <4 years; 0, 1, and 6 months if age ≥4 years.
    • Adults who have had 1 or 2 prior polio vaccine doses should get the final 1 or 2 doses per the standard interval.
  • No additional doses are recommended for those previously fully vaccinated.
  • See Polio, Vaccine* and Poliovirus, Poliomyelitis*.

AHA Scientific Statement on Endocarditis in PWID

New Practice Guidelines

  • Management of Helicobacter pylori infection, from the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy (Dig Liver Dis 2022;54:1153). PDF available here.

Fluoroquinolones and Acute Liver Injury

  • In a nationwide register-based cohort study conducted in Sweden, oral fluoroquinolone use was associated with a 2-fold increased risk of acute liver injury (compared to amoxicillin) within a 60-day period after the start of treatment. The absolute risk was low (estimated to be five additional events per one million courses of treatment). The majority of treatment courses consisted of ciprofloxacin (79.3%), followed by norfloxacin (17.4%), moxifloxacin (1.78%), levofloxacin (1.11%), and ofloxacin (0.47%) (Clin Infect Dis 2022;74:2152). PDF available at PMC.

Antimicrobial Stewardship Pearl

  • A quality improvement initiative led to improved antibiotic use and decreased urine cultures in patients with asymptomatic bacteriuria* (ASB).  Case-based teaching was used to instruct users to apply an algorithm to differentiate urinary tract infection from ASB.  This led to a reduction in urine cultures by 3.24 urine cultures per 1000 bed-days, and a 21.7% decrease in days of antibiotic therapy. These findings highlight a viable strategy for implementing an antimicrobial stewardship initiative for ASB. (JAMA Netw Open 2022;5(7):e2222530). 

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of September 11, 2022) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since August 7, 2022:
      • Isoniazid 300 mg tablets
      • Rifaximin 200 mg tablets
    • Shortage recently resolved:
      • Cefepime injection
      • Daptomycin injection
      • Neomycin and Polymyxin B sulfates GU irrigant
      • Rifapentine tablets
    • Antibacterial and antimycobacterial drugs in continued reduced supply:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection
        • Neomycin tablets
        • Tobramycin injection
      • Carbapenems:
        • Meropenem injection
      • Cephalosporins:
        • Cefazolin injection
        • Cefixime 400 mg capsules
        • Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Provepharm Life Solutions and its distributor Direct Success. Click here for details),
        • Ceftazidime injection
        • Cefuroxime injection
      • Clindamycin injection
      • Doxycycline oral suspension
      • Fluoroquinolones:
        • Ciprofloxacin 0.3% ophthalmic solution
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1% (unavailable)
        • Erythromycin 0.5% ophthalmic ointment
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Penicillin G sodium 5 million units/vial (10 count)
        • Piperacillin-tazobactam injection
      • Quinupristin-Dalfopristin injection
      • Topical (miscellaneous) antibacterials:
        • Bacitracin ophthalmic ointment (unavailable)
        • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
        • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs in continued reduced supply
      • Amphotericin B Lipid Complex (not liposomal)
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs in continued reduced supply
      • Rifampin capsules
      • Rifampin injection
    • Antiviral drugs in continued reduced supply
      • None
    • Vaccines in continued reduced supply:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Gemifloxacin 320 mg tablet (August 2022, no further US distribution)
    • Gentamicin sulfate 0.3% ophthalmic ointment (July 2022)
    • Mupirocin calcium 2% cream (Bactroban [GSK], June 2020)
    • Bacitracin injection (February 2020)
    • Interferon alfa-2b (Intron A, October 2019)
    • Mupirocin calcium 2% nasal ointment (Bactroban Nasal [GSK], August 2019)