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2018 Infectious Disease Update Archive

Dec 31st 2018

Table of Contents

NOTE: Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal.

View All Infectious Disease Updates

January 2018 Infectious Disease Update

New Drug Approvals

  • Biktarvy* (bictegravir, emtricitabine, tenofovir alafenamide) for the treatment of HIV-1 infection in adults with no prior antiretroviral treatment history, or to replace the current regimen in a patient virologically suppressed on a stable regimen for at least three months with no history of treatment failure or known substitutions associated with resistance to bictegravir, emtricitabine, or TAF. Recommended dosage: one tablet once daily, with or without food.
  • Symfi Lo* (efavirenz, lamivudine, tenofovir disoproxil fumarate) for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 35 kg. Recommended dosage: one tablet once daily on an empty stomach, preferably at bedtime to improve tolerability of CNS side effects.
  • Firvanq (vancomycin oral solution), indicated for the treatment of C. difficile* associated diarrhea in adults and pediatric patients <18 years of age, and also for the treatment of enterocolitis caused by Staph. aureus (including MRSA) in adults and pediatric patients <18 years of age. Product availability: kits containing vancomycin powder (3.75, 7.5, 10.5, or 15 gm) and grape-flavored diluent that provide final drug concentrations of 25 mg/mL and 50 mg/mL after reconstitution. Expected product launch: early April, 2018.

New FDA-approved Indications

  • Ceftazidime-avibactam* is now indicated for the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Serratia marcescens, Proteus mirabilis, Pseudomonas aeruginosa, and Haemophilus influenzae in patients 18 years of age or older. The drug was previously approved for complicated intra-abdominal infection (in combination with metronidazole) and complicated UTI, including pyelonephritis.

From the Centers for Disease Control and Prevention

  • February 9 CDC update on widespread influenza activity, including an audio recording. Click here.
  • Weekly US Influenza Surveillance Report. Click here.
  • The 2018 recommended immunization schedule for children and adolescents aged 18 years or younger. Click here.
  • The 2018 recommended immunization schedule for adults aged 19 or older. Click here.
  • Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) and CDC regarding prevention of hepatitis B infection in the US (MMWR Recomm Rep 67:1, 2018). Available for download here.

Newly Released Treatment Guidelines

  • Clinical guidelines for the diagnosis and treatment of catheter-related bloodstream infection from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) (Med Intensiva 42:5, 2018). The last Spanish catheter-related infections guidelines were published in 2004. The new guidelines are available for download on the SEIMC and SEMICYUC websites.
  • 2017 update of the German clinical guideline on epidemiology, diagnostics, therapy, prevention, and management of uncomplicated urinary tract infections in adult patients (Urol Int 2018 Jan 17 [Epub ahead of print]). This is an update of the 2010 version and is available for download on the Karger website.
  • 2017 update of the guideline for epidemiology, diagnosis, and treatment of adult patients with nosocomial pneumonia from the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology (Pneumologie 72:15, 2018). This is an update of the 2012 version.
  • Guidelines for the diagnosis and treatment of community-acquired pneumonia in adults who present to the hospital from the Dutch Working Party on Antibiotic Policy in collaboration with the Dutch Association of Chest Physicians, the Dutch Society for Intensive Care, and the Dutch College of General Practitioners (Neth J Med 76:4, 2018). These guidelines update the 2011 version and are available for download on the journal website.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Azithromycin injection, Oseltamivir oral suspension
    • [Shortage recently resolved]: Penicillin G benzathine
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Tobramycin injection
      • Cephalosporins: Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin oral suspension, Moxifloxacin injection, Ofloxacin 0.3% ophthalmic solution
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R), Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Clindamycin injection, Doxycycline injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • Vaccines: Hepatitis A Virus Vaccine Inactivated (Vaqta), Hepatitis B vaccine recombinant, Yellow Fever vaccine (unavailable)
  • 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

March 2018 Infectious Disease Update

Sanford Guide to Antimicrobial Therapy 2018

  • New print editions of the Sanford Guide to Antimicrobial Therapy are expected to be available within the next two weeks. To learn more about what updates are included or to pre-order books, visit our Online Store.

Drug Safety Communications

  • The US FDA is advising caution when considering the use of clarithromycin* in patients with heart disease because of the potential for increased long-term risk of heart problems or death. This recommendation is based on a review of the results of a 10-year follow-up study of patients with coronary heart disease from a large clinical trial that first observed this safety issue. The full Drug Safety Communication can be found here.

New Generic Approval

Newly Released Treatment Guidelines

Antibiotic Stewardship

  • Fluoroquinolones* (FQ) are associated with serious toxicities, and the US FDA has recently cautioned prescribers to avoid using them if alternative and effective drugs are available. Nevertheless, a recent study suggests that about 5.1% of adult ambulatory FQ prescriptions are written for conditions such as viral URIs and bronchitis that don’t require antibiotics, and 19.9% are for conditions where FQs are not considered firstline choices (sinusitis and uncomplicated UTI). Antibiotic stewardship efforts should be directed against inappropriate FQ use (Clin Infect Dis 2018 Jan 24 [Epub ahead of print]).
  • Carbapenem-resistant Enterobacteriaceae (CRE), such as carbapenem-resistant Klebsiella pneumoniae (CRKP), is associated with limited treatment options and poor outcomes. In addition, resistance to last-line drugs such as colistin is increasing. In the first report of colistin heteroresistance in K. pneumoniae in the US, two multidrug-resistant CRKP urine isolates deemed colistin susceptible by clinical diagnostics were found to harbor a minor colistin-resistant subpopulation. This subpopulation became dominant when grown in the presence of colistin but returned to baseline levels when grown in media free of colistin. To assess possible in vivo relevance, mice infected with either strain did not survive the infection, even in the presence of colistin. This suggests the possibility of patients with colistin-susceptible CRKP strains failing colistin therapy and underscores the importance of improved diagnostics (MBio 9:e02448, 2018).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Ciprofloxacin injection, Dalbavancin injection
    • [Shortage recently resolved]: Ofloxacin 0.3% ophthalmic solution
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Tobramycin injection
      • Cephalosporins: Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin oral suspension, Moxifloxacin injection
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R), Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Clindamycin injection, Doxycycline injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: Oseltamivir oral suspension
      • Vaccines: Hepatitis A Virus Vaccine Inactivated (Vaqta), Hepatitis B vaccine recombinant, Yellow Fever vaccine (unavailable)
  • 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/DrugShortages

April 2018 Infectious Disease Update

Newly Released Treatment Guidelines

From the Centers for Disease Control and Prevention

  • A yellow fever* outbreak began in Brazil in December 2016. Since January 2018, 10 travel-related cases, including four deaths, have been reported in international travelers returning from Brazil. Eight of the travelers acquired the disease on the island of Ilha Grande, off the Rio de Janeiro coast. All 10 travelers were unvaccinated. Yellow fever vaccination is recommended for all eligible persons aged ≥9 months traveling to many areas of Brazil. YF-VAX, the US FDA-approved vaccine, is currently unavailable; an alternative vaccine not licensed in the US, Stamaril, can be obtained through a limited number of clinics in the US (click here). Vaccination should occur at least 10 days before travel, and recommendations to avoid mosquito bites should be followed (MMWR 67:340, 2018).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Cefpodoxime oral suspension (unavailable)
    • [Shortage recently resolved]: Ofloxacin 0.3% ophthalmic solution
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Tobramycin injection
      • Cephalosporins: Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Ceftazidime, Ceftriaxone, Cefuroxime injection (unavailable)
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin oral suspension, Moxifloxacin injection (unavailable)
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R), Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Clindamycin injection, Dalbavancin injection (unavailable), Doxycycline injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: Oseltamivir oral suspension
      • Vaccines: Hepatitis A Virus Vaccine Inactivated (Vaqta), Hepatitis B vaccine recombinant, Yellow Fever vaccine (unavailable)
  • 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

May 2018 Infectious Disease Update

New Drug Approvals

  • Cimduo* (lamivudine, tenofovir disoproxil fumarate) for the treatment of HIV-1 infection (in combination with other antiretroviral agents) in adult and pediatric patients weighing at least 35 kg. Recommended dosage: one tablet once daily, with or without food.
  • Trogarzo* (ibalizumab-uiyk), in combination with other antiretrovirals, for the treatment heavily treatment-experienced adults with multidrug-resistant HIV-1 infection failing their current regimen. Ibalizumab is a monoclonal antibody that prevents HIV fusion and entry into the CD4 cell. Recommended dosage: 2 gm IV loading dose, then 800 mg IV every two weeks.

New FDA Indication

  • Otiprio (ciprofloxacin* 6% otic suspension) for the treatment of acute otitis externa due to P. aeruginosa and S. aureus in patients 6 months of age and older. The product was previously approved for bilateral otitis media with effusion in patients (age 6 months and older) undergoing tympanostomy tube placement. Recommended dosage for acute otitis externa: a single 0.2 mL administration to the external ear canal of each affected ear.

New or Updated Treatment Guidelines

  • Clinical practice guidelines for the diagnosis and treatment of cutaneous leishmaniasis (CL) in Turkey. These guidelines are a consensus text prepared by 18 experienced CL specialists who have been working for many years in areas where the disease is endemic (Int J Dermatol 2018 Apr 16 [Epub ahead of print]).
  • Guidelines for vaccine use in cancer patients, including autologous stem cell transplant recipients, from the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) (Ann Oncol 2018 Apr 24 [Epub ahead of print]). the guidelines are available on the journal website.
  • Korean clinical practice guidelines for the antibiotic treatment of community-acquired urinary tract infections (Infect Chemother 50:67, 2018). These guidelines update the 2011 Korean guidelines and are available on the journal website.
  • Updated clinical practice guidelines from the US Public Health Service for the use of pre-exposure prophylaxis (PrEP) to prevent HIV infection, available on the CDC website. They include new information on the safety and efficacy of PrEP, indications for PrEP use, and links to further information. Changes in the updated guidelines are highlighted.
  • 2017 guidelines for HIV pre-exposure prophylaxis (PrEP) from the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. These guidelines update the 2015 version and represent an adaptation and update of the 2014 US CDC PrEP guidelines (J Virus Erad 4:143, 2018).

From the Centers for Disease Control and Prevention

  • A recently published report compiles and summarizes all recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the US. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and it replaces all previously published reports and policy notes. It is intended for use by clinicians and public health providers as a resource (MMWR 67(2):1-44, 2018).

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Gentamicin ophthalmic ointment (unavailable)
    • [Shortage recently resolved]: Ofloxacin 0.3% ophthalmic solution
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Tobramycin injection
      • Cephalosporins: Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Cefpodoxime oral suspension, Ceftazidime, Ceftriaxone, Cefuroxime injection (unavailable)
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin oral suspension, Moxifloxacin injection (unavailable)
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R), Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Clindamycin injection, Dalbavancin injection, Doxycycline injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: Oseltamivir oral suspension
      • Vaccines: Hepatitis A Virus Vaccine Inactivated (Vaqta), Hepatitis B vaccine recombinant, 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

June 2018 Infectious Disease Update

Drug Safety Communications

  • The US FDA has issued a Drug Safety Communication regarding the possible increased risk of neural tube defects among infants born to women who became pregnant while on a dolutegravir-based regimen, based on preliminary results from an ongoing observational study in Botswana. There is no evidence from this study of neural tube defects occurring among infants born to women who initiated a dolutegravir-based regimen after becoming pregnant. Dolutegravir is available as a single agent (brand name Tivicay*) and is also part of the combination products Juluca* and Triumeq*. The full Drug Safety Communication can be found here. The most current recommendations from the HHS Antiretroviral Guidelines Panels, with clinical scenarios and alternatives to treatment with dolutegravir, can be found here. An interim statement from CDC can be found here.

CDC Health Alert Network #411

  • HAN #411 provides current CDC recommendations on the management and reporting of Shigella* infections that have been treated with ciprofloxacin or azithromycin and resulted in possible clinical treatment failure. This is a follow-up to HAN #401 (April 2017) which described an increase in the percentage of Shigella isolates in the US with ciprofloxacin MICs of 0.12–1 μg/mL (classified as susceptible by CLSI criteria). This percentage continues to rise. Molecular data indicate that Shigella isolates in this ciprofloxacin MIC range harbor at least one quinolone resistance mechanism. CDC has also identified an increasing number of Shigella isolates with azithromycin MICs that exceed the epidemiological cutoff value (ECV), and requests reports of any possible azithromycin treatment failures.

New or Updated Treatment Guidelines

Antiretroviral Labeling Changes

  • The approved labeling for darunavir/cobicistat (Prezcobix*) now specifically states that this combination product is not recommended for use in pregnant women due to substantially lower exposures of darunavir and cobicistat. Treatment should not be initiated in pregnant women, and an alternative regimen should be used in women who become pregnant during Prezcobix therapy.
  • The US FDA has approved once-daily oral emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg (Truvada*), in combination with safe sex practices, for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 in at-risk adolescents weighing at least 35 kg. Truvada was approved for PrEP in adults in 2012.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Cefazolin, Nitrofurantoin oral suspension (unavailable), Recombinant zoster vaccine (Shingrix)
    • [Shortage recently resolved]: Doxycycline injection, Oseltamivir oral suspension, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R)
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Cephalosporins: Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Cefpodoxime oral suspension, Ceftazidime, Ceftriaxone, Cefuroxime injection (unavailable)
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin oral suspension, Moxifloxacin injection (unavailable)
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Clindamycin injection, Dalbavancin injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • Vaccines: Hepatitis A Virus Vaccine Inactivated (Vaqta), Hepatitis B vaccine recombinant, 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)

July 2018 Infectious Disease Update

New Drug Approval

  • Plazomicin, a new aminoglycoside derived from sisomicin, was approved by the US FDA in late June 2018 for treatment of adults with complicated urinary tract infections (UTIs), including pyelonephritis, caused by these susceptible microbes: E. coli, K. pneumoniae, P. mirabilis, and E. cloacae. The clinical significance of in vitro activity against other gram-negative bacilli is unknown at this time. Activity against P. aeruginosa is variable, and the drug has no activity against A. baumannii, S. maltophilia, or anaerobes. Safety and efficacy data are limited, so Plazomicin should be used only where there are limited or no alternative treatment options. The recommended dosage is 15 mg/kg IV q24h for 4-7 days.

New or Updated Treatment Guidelines

  • Guidelines for proper utilization of the microbiology laboratory for diagnosis of infectious diseases, from the Infectious Diseases Society of America (IDSA) and American Society for Microbiology (ASM) (Clin Infect Dis 2018 June 28 [Epub ahead of print]). These guidelines update recommendations published in 2013 and are available on the IDSA website.
  • Executive summary of clinical practice guidelines (2018 update) for the management of invasive aspergillosis, prepared by The Study Group of Fungal Infections (GEMICOMED) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) (Enferm Infecc Microbiol Clin 2018 June 27 [Epub ahead of print]).

From CDC

  • Updated recommendations for use of once-weekly INH-rifapentine for LTBI. In 2011, CDC recommended 3 months of once-weekly isoniazid and rifapentine (3HP) by directly observed therapy (DOT) for treatment of latent tuberculosis infection (LTBI), with limitations for use in children <12 years and in patients with HIV. Based on a systematic review of published evidence and after consideration of input from TB experts, the Advisory Council for the Elimination of TB, and the public, CDC continues to recommended 3HP for adults with LTBI and now recommends it (1) for persons aged 2-17, (2) for persons with HIV infection, including AIDS, who are taking antiretroviral drugs with manageable drug-drug interactions with rifapentine, and (3) by DOT or self-administered therapy in persons ≥2 years of age. Full discussion: MMWR 67(25): 723-726, 2018.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Azithromycin ophthalmic solution 1% (unavailable)
    • [Shortage recently resolved]: Dalbavancin injection, Doxycycline injection, Oseltamivir oral suspension, Penicillin G benzathine/Penicillin G procaine 1.2 million units (Bicillin C-R)
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Cephalosporins: Cefazolin, Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Cefpodoxime oral suspension, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin oral suspension, Gemifloxacin tablets, Moxifloxacin injection (unavailable)
      • Penicillins: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets, Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Clindamycin injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension (unavailable), Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • Vaccines: Hepatitis A virus vaccine inactivated (Vaqta), 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)

August 2018 Infectious Disease Update

Drug Safety Communications

  • The US FDA is warning that azithromycin should not be given long-term to prevent bronchiolitis obliterans syndrome (BOS) in patients who have undergone allogeneic hematopoietic stem cell transplantation (HSCT) for hematological malignancy. This alert follows the early termination of a trial investigating the efficacy of long-term azithromycin for preventing BOS after an increased risk of relapse and death was observed in patients taking azithromycin compared with placebo. A plausible mechanism has not been identified. The full Drug Safety Communication can be found here.

New Drug Approvals

  • Arakoda (tafenoquine), approved for malaria prophylaxis in patients aged 18 and older. The recommended dosage is a loading regimen of 200 mg once daily for each of the three days before travel to a malarious area, a maintenance regimen of 200 mg once weekly while in the malarious area (starting seven days after the last loading regimen dose), and then 200 mg (a single dose) in the week following exit from the malarious area (seven days after the last maintenance dose). Product availability: 100 mg tablets.
  • Krintafel (tafenoquine)*, approved for the radical cure (prevention of relapse) of Plasmodium vivax malaria in patients aged 16 and older. The recommended dosage is a single 300 mg dose coadministered on the first or second day of appropriate therapy for acute P. vivax malaria. Product availability: 150 mg tablets.
  • Symtuza* (darunavir 800 mg, cobicistat 150 mg, emtricitabine 200 mg, and tenofovir alafenamide 10 mg), approved for the treatment of HIV-1 infection in adults who are 1) treatment naive, or 2) virologically suppressed on an ARV regimen for at least 6 months and have no known substitutions associated with darunavir or tenofovir resistance. The recommended dosage is one tablet once daily with food.
  • TPOXX (tecovirimat)*, approved for the treatment of human smallpox disease caused by variola virus in adults and pediatric patients weighing at least 13 kg. Clinical studies in humans have not been conducted; the effectiveness of tecovirimat was established based on animal efficacy studies. The drug works by inhibiting the orthopoxvirus VP37 envelope wrapping protein. Recommended dosage in patients weighing ≥40 kg is 600 mg (three 200 mg capsules) po bid for 14 days. Pediatric dosage: weight 13 to <25 kg, 200 mg bid; 25 to <40 kg, 400 mg bid.

New or Updated Treatment Guidelines

  • Updated recommendations regarding the use of antiretroviral drugs for treatment and prevention of HIV infection in adults, from the International Antiviral Society-USA (IAS-USA) Panel (Saag MS et al, JAMA 320:379, 2018). These recommendations update the 2016 version and are available on the JAMA website.
  • Updated recommendations regarding testing and monitoring for antiretroviral drug resistance in HIV-infected individuals, from the International Antiviral Society-USA (IAS-USA) Panel (Clin Infect Dis 2018 July 20 [Epub ahead of print]). These recommendations update the 2008 version.
  • Belgian guidelines for the screening for latent tuberculosis in HIV-infected patients, from members of the Belgian LTBI group in consultancy with the AIDS Reference Center College (Acta Clin Belg 2018 July 23 [Epub ahead of print]).
  • A summary of the updated guidelines on primary antifungal prophylaxis in adult hematology patients, from The European Conference on Infections in Leukaemia (ECIL). Compared to the 2011 version, major changes include implementation of the IDSA grading system and extension of the recommendations to other hematological diseases besides AML and allogeneic HSCT recipients. This publication summarizes the proposals agreed upon at ECIL-5 and ECIL-6 (J Antimicrob Chemother 2018 Aug 1 [Epub ahead of print]).
  • Updated clinical practice guidelines for the treatment of chronic hepatitis C, from the Korean Association for the Study of the Liver (Clin Mol Hepatol 2018 August 10 [Epub ahead of print]). The last update was in 2015. These guidelines are available on the journal website.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Ciprofloxacin 0.3% ophthalmic solution
    • [Shortage recently resolved]: Amoxicillin/clavulanate 1000 mg/62.5 mg ER tablets
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment, Tobramycin injection
      • Cephalosporins: Cefazolin, Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Cefpodoxime oral suspension, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin oral suspension, Gemifloxacin tablets, Moxifloxacin injection (unavailable)
      • Penicillins: Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Clindamycin injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension, Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • Vaccines: Hepatitis A virus vaccine inactivated (Vaqta), 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 2018 Infectious Disease Update

Sanford Guide App Upgrades

  • In the next few weeks, Sanford Guide mobile app users will begin receiving content updates in real time, replacing our monthly content update cycle. This will allow users to access new guidelines as soon as our editorial board publishes them, and eliminate interruptions by downloading updates in the background. Keep an eye out for app updates and download the latest versions to begin utilizing this new functionality as it becomes available. Tutorials for our mobile apps are available on our YouTube channel.

Drug Safety Communications

  • Based on its recent review, the US FDA is strengthening the current warnings in the prescribing information that fluoroquinolone antibiotics may cause significant decreases in blood sugar and certain mental health side effects. These labeling changes are required only of systemic fluoroquinolone formulations. Blood sugar disturbances are already included as a warning in most fluoroquinolone drug labels; the FDA is adding that hypoglycemia can lead to coma. The new label changes will make the mental health side effects of fluoroquinolones more prominent and more consistent; side effects to be added or updated across all the fluoroquinolones are disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium. The full Drug Safety Communication can be found here.

New Drug Approvals

  • Xerava (eravacycline*), a tetracycline-like drug approved for the treatment of complicated intra-abdominal infections in patients 18 years of age and older. The recommended dosage is 1 mg/kg (over 60 minutes) IV q12h x4-14 days depending on infection severity and clinical response. Product availability: 50 mg single-dose vials.
  • Pifeltro (doravirine*), a non-nucleoside reverse transcriptase inhibitor (NNRTI) approved for the treatment of HIV-1 infection (in combination with other antiretroviral agents) in treatment-naive adults. The recommended dosage is 100 mg orally once daily, with or without food. Product availability: 100 mg film-coated tablets.
  • Delstrigo*, a fixed-dose combination product of doravirine (100 mg), lamivudine (300 mg), and tenofovir disoproxil fumarate (300 mg), approved for the treatment of HIV-1 infection in treatment-naive adults. The recommended dosage is one tablet orally once daily, with or without food. Product availability: film-coated tablets.
  • Moxidectin*, an antihelmintic approved for the treatment of onchocerciasis due to Onchocerca volvulus in patients 12 years of age and older. The recommended dosage is a one-time dose of 8 mg, taken with or without food. Product availability: 2 mg tablets.

New or Updated Treatment Guidelines

  • Updated clinical practice guidelines for antimicrobial prophylaxis in adult patients with cancer-related immunosuppression, from the American Society of Clinical Oncology in partnership with the Infectious Diseases Society of America (J Clin Oncol 2018 Sept 4 [Epub ahead of print]). This release updates the 2013 guidelines and is available on the JCO website.
  • Recommendations for routine use of the seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children, from the American Academy of Pediatrics (AAP) for the upcoming 2018-2019 season (Pediatrics 2018 Sept 3 [Epub ahead of print]). The recommendations are available on the AAP website.

From CDC

  • The 2018–19 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the US have been released (MMWR Recomm Rep 2018; 67(No. RR-3):1–20. Routine annual vaccination of all persons aged ≥6 months without contraindications continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. Other important updates:
    1. Vaccine viruses will be an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).
    2. For the 2018–19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 (not recommended the last two seasons) is an option for those for whom it is appropriate. Note: IIV=inactivated influenza vaccine, RIV=recombinant influenza vaccine, LAIV=live attenuated influenza vaccine; 4=quadrivalent vaccine.
    3. Persons with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine (IIV, RIV4, or LAIV4) that is otherwise appropriate for their health status. Additional recommendations concerning vaccination of egg-allergic persons are discussed.
    4. Recent licensure and labeling changes are reviewed, including expansion of the age indication for Afluria Quadrivalent (IIV4) from ≥18 years to ≥5 years and expansion of the age indication for Fluarix Quadrivalent (IIV4), previously licensed for ≥3 years, to ≥6 months.

    The full report is available on the MMWR website.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Daptomycin
    • [Shortage recently resolved]: Moxifloxacin injection
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Cephalosporins: Cefazolin, Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Cefpodoxime oral suspension, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
      • Penicillins: Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Clindamycin injection, Erythromycin lactobionate injection (unavailable), Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension, Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • Vaccines: Hepatitis A virus vaccine inactivated (Vaqta), 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)

October 2018 Infectious Disease Update

New Drug Approvals

  • Arikayce (amikacin* liposome inhalation suspension), approved for the treatment of Mycobacterium avium complex (MAC) lung disease as part of a combination antibacterial drug regimen for adult patients who have limited or no alternative treatment options. It is the first product approved via the Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD), which serves to advance the development of new antibacterial drugs to treat serious or life-threatening infections in limited populations of patients with unmet needs. The recommended dosage is once-daily inhalation of the contents of one 590 mg/8.4 mL vial, using the Lamira Nebulizer System.
  • Nuzyra (omadacycline*), a tetracycline-like drug approved for the treatment of community-acquired pneumonia and acute bacterial skin and skin structure infections. The recommended dosage for CAP is 200 mg IV load, followed by 100 mg IV (or 300 mg po) q24h x7-14 days. For ABSSSI, the recommended dosage is 200 mg IV (or 450 mg po q24h x2) load, followed by 100 mg IV (or 300 mg po) q24h x7-14 days. Product availability: Injection (100 mg single-dose vials), 150 mg tablets.

New or Updated Treatment Guidelines

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Dalbavancin injection, Mafenide powder for solution, Meropenem injection
    • [Shortage recently resolved]: Moxifloxacin injection
    • [Continue to be in reduced supply]:
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Cephalosporins: Cefazolin, Cefepime, Cefotaxime injection (unavailable), Cefoxitin, Cefpodoxime oral suspension, Ceftazidime, Ceftriaxone, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
      • Macrolides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable)
      • Penicillins: Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Clindamycin injection, Daptomycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension, Vancomycin injection
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • 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)

November 2018 Infectious Disease Update

Counterfeit Book Alert

  • It has come to our attention that Amazon.com has been selling and fulfilling orders for The Sanford Guide to Antimicrobial Therapy with counterfeits. We cannot vouch for the accuracy of these books, and strongly discourage their use in clinical situations. For more information on how to detect a counterfeit and what to do if you have one, visit https://www.sanfordguide.com/products/print-guides/.

New Drug Approvals

  • Xofluza (baloxavir marboxil), approved for the treatment of acute uncomplicated influenza in patients ≥12 years of age who have been symptomatic for ≤48 hours. The recommended dosage is a single dose (within 48 hours of symptom onset) with or without food (40 mg for body weight 40 to <80 kg, 80 mg for ≥80 kg). Product availability: 20 mg and 40 mg tablets.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Cidofovir injection (unavailable), Letermovir injection
    • [Shortage recently resolved]: Moxifloxacin 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, Cefpodoxime oral suspension, Ceftazidime injection, Ceftriaxone injection, Cefuroxime injection
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
      • Glyco-, glycolipo-, lipopetides: Dalbavancin injection, Daptomycin injection, Vancomycin injection
      • Macrolides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable)
      • Penicillins: Ampicillin/sulbactam, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Clindamycin injection, Mafenide powder for solution, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: None
      • 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)

December 2018 Infectious Disease Update

New Drug Approvals

  • Aemcolo (rifamycin SV*), approved for the treatment of travelers’ diarrhea caused by non-invasive strains of E. coli in adults. Rifamycin SV is a poorly absorbed member of the rifamycin (technically ansamycin) class of antibiotics that was actually the first to be used in clinical practice (1963). In theory the product’s MMX (multimatrix) technology allows for release of active antibiotic only after it reaches intestinal pH levels of ≥7 in the distal small bowel and colon, with an additional 1 hour delay upon reaching this pH. The recommended dosage is 388 mg po bid x3 days, with or without food (but not with alcohol). Tablets should be swallowed whole (not crushed, chewed, or broken) with 6-8 ounces of fluid. Rifamycin SV interacts with many CYP450 and transporter proteins, but because of negligible systemic rifamycin concentrations no clinically relevant drug interactions are expected. Product availability: 194 mg tablets.
  • Temixys* (lamivudine 300 mg + tenofovir disoproxil fumarate 300 mg), approved (in combination with other antiretroviral agents) for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 35 kg. This product is a generic formulation that has essentially the same activity and safety profile as Truvada (emtricitabine + tenofovir disoproxil fumarate). The recommended dosage is one tablet once daily, with or without food.

New or Updated Treatment Guidelines

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list]: Nystatin oral suspension
    • [Shortage recently resolved]: Cefpodoxime oral suspension, Mafenide 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
      • Fluoroquinolones: Ciprofloxacin injection, Ciprofloxacin 0.3% ophthalmic solution, Ciprofloxacin oral suspension, Gemifloxacin tablets
      • Glyco-, glycolipo-, lipopeptides: Dalbavancin injection, Daptomycin injection, Vancomycin injection
      • Macrolides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable), Erythromycin lactobionate injection (unavailable)
      • Penicillins: Ampicillin/sulbactam injection, Oxacillin injection, Penicillin G procaine injection (unavailable), Piperacillin/tazobactam
      • Other antibacterials: Clindamycin injection, Metronidazole injection, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Nitrofurantoin oral suspension
      • Antifungal drugs: Fluconazole injection
      • Antiparasitic drugs: None
      • Antiviral drugs: Cidofovir injection (unavailable), Letermovir injection
      • 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)
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