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Jan '22 Infectious Disease Update

Jan 11th 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.

January 2022

SARS-CoV-2 / COVID-19

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

  • January 3: The US FDA amends the EUA for the Pfizer-BioNTech COVID-19 vaccine to:
    • Expand the use of a single booster dose to include use in individuals 12 through 15 years of age.
    • Shorten the time between the completion of primary vaccination with the Pfizer-BioNTech vaccine and a booster dose to at least five months.
    • Allow for a third primary series dose for certain immunocompromised children 5 through 11 years of age.
  • December 23: The US FDA issues an EUA for molnupiravir for the treatment of mild-to-moderate COVID-19 disease in adults with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate. Molnupiravir should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. Rcommended dosage: 800 mg (four 200 mg capsules) po q12h for five days.
  • December 22: The US FDA issues an EUA for nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use (Paxlovid) for the treatment of mild-to-moderate COVID-19 disease in adults and pediatric patients (≥12 years, weight ≥40 kg) with positive results of direct SARS-CoV-2 testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Nirmatrelvir + ritonavir should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. Recommended dosage: nirmatrelvir 300 mg twice daily + ritonavir 100 mg twice daily (taken together) for five days.
  • CDC: Interim public health recommendations for fully vaccinated people here.
  • 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 2021 Nov 22 [online ahead of print]). 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.

Clindamycin Vaginal Gel for BV

  • The US FDA has approved clindamycin phosphate vaginal gel, 2% (Xaciato)* for the treatment of bacterial vaginosis in females 12 years of age and older. Recommended dosage: one applicatorful (5 gm of vaginal gel containing 100 mg of clindamycin) administered once intravaginally as a single dose at any time of the day.

New or Updated Practice Guidelines

Injectable Cabotegravir for PrEP

  • The US FDA has approved Apretude (cabotegravir extended-release injectable suspension)* for pre-exposure prophylaxis (PrEP)* to reduce the risk of sexually acquired HIV-1 infection in at-risk adults and adolescents weighing ≥35 kg. Recommended dosage: Initiation with a 600 mg/3 mL IM injection administered one month apart for two consecutive months, then continuation with a single 600 mg/3 mL IM injection administered every two months. Lead-in with oral cabotegravir (30 mg po once daily x28 days) may be administered before initiating the first injection to assess tolerability.

Dengue Vaccine Recommendations

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of January 10, 2022) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New on the list since December 13, 2021:
      • Acyclovir injection, Posaconazole injection, Rifampin injection
    • Shortage recently resolved:
      • Ceftolozane-tazobactam injection
    • Antibacterial and antimycobacterial drugs in continued reduced supply:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection
        • Gentamicin sulfate 3% ophthalmic ointment
        • Neomycin tablets
        • 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 Provepharm Life Solutions and its distributor Direct Success. Click here for details),
        • Ceftazidime injection
      • Clindamycin injection
      • Doxycycline oral suspension
      • Fluoroquinolones:
        • Ciprofloxacin 0.3% ophthalmic solution
        • Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1% (unavailable)
      • Methanamine hippurate tablets
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules
        • Piperacillin-tazobactam injection
      • Topical (miscellaneous) antibacterials:
        • Bacitracin ophthalmic ointment
        • Neomycin and Polymyxin B sulfates GU irrigant
        • Neomycin and Polymyxin B sulfates and Dexamethasone ophthalmic ointment
        • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
        • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs in continued reduced supply:
      • Amphotericin B injection
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs in continued reduced supply:
      • Ethambutol tablets
      • Rifapentine tablets
    • Antiviral drugs in continued reduced supply:
      • Tocilizumab injection
    • Vaccines in continued reduced supply:
      • Hepatitis B vaccine recombinant
  • Antimicrobial drugs recently discontinued:
    • 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)
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