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Dec '22 Infectious Disease Update

Dec 13th 2022

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board and Antimicrobial Stewardship Program Manager. 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.
 

December 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.

  • 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.

Antimicrobial Stewardship Pearl

  • A national cohort study evaluated the risk of adverse drug events and attributable health care expenditures associated with inappropriate versus appropriate antibiotic prescriptions for respiratory infections in adult outpatients.  Of the over 3 million eligible adults, 43%-56% received inappropriate antibiotics for bacterial and 7-66% for viral infections. Inappropriate antibiotics were associated with an increased risk of adverse drug events, including Clostridioides difficile infection, and higher health care costs. This study provides further evidence that there is a need to expand antimicrobial stewardship programs to outpatient settings to improve quality of care and reduce expenditures.  Clin Infect Dis. 2022; ciac879, https://doi.org/10.1093/cid/ciac879

Second Indication for Ibrexafungerp

  • The US FDA has approved ibrexafungerp* for the reduction in the incidence of recurrent vulvovaginal candidiasis in adult and post-menarchal pediatric females. The recommended dosage to prevent recurrences is 300 mg po q12h x2 doses, administered monthly for six months, with or without food.

Updated ARV Guidelines

  • Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the IAS-USA panel (JAMA 2022 Dec 1 [online ahead of print]). These guidelines update the 2020 consensus recommendations.

Priorix: ACIP Recommendations

  • Since 1978, only one MMR vaccine*, M-M-R II (Merck), has been available in the US. Last June US FDA approved a second MMR vaccine, Priorix (GlaxoSmithKline Biologicals), for the prevention of measles, mumps, and rubella in persons aged ≥12 months. The three live attenuated viruses contained in the new vaccine are genetically similar or identical to the corresponding viruses in M-M-R II. The Advisory Committee on Immunization Practices (ACIP) has unanimously recommended Priorix as an option to prevent measles, mumps, and rubella according to the existing recommended schedules and for off-label uses. Priorix and M-M-R II are fully interchangeable for all indications for which MMR vaccination is recommended. This report contains ACIP recommendations specific to Priorix and supplements the existing ACIP recommendations for MMR use (MMWR 2022;71:1465-70). PDF available here.

Update on Meningococcal Vaccines

  • MenQuadfi*, Meningococcal (Groups A, C, Y, W) Conjugate Vaccine, has fully replaced the discontinued Menactra as the sole quadrivalent vaccine available from Sanofi. MenQuadfi is approved for use in persons 2 years of age and older. Menveo (GSK) is approved for use in persons 2 months through 55 years of age, but may be used off-label in older adults.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of December 11, 2022) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • New shortages since November 6, 2022:
      • Amphotericin B injection
      • Azithromycin injection
      • Amoxicillin-clavulanate (all formulations)
      • Rifapentine 150 mg tablets
    • Shortage recently resolved:
      • Penicillin G sodium injection
    • Antibacterial drugs:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection
        • Neomycin tablets
        • Tobramycin injection
      • Bacitracin ophthalmic ointment (unavailable)
      • 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:
        • Dalbavancin injection
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1% (unavailable)
        • Erythromycin 0.5% ophthalmic ointment
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Amoxicillin (all oral formulations)
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Piperacillin-tazobactam injection
      • Quinupristin-Dalfopristin injection
      • Rifaximin 200 mg tablets
      • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
      • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs: 
      • Amphotericin B Lipid Complex (ABLC)
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs: 
      • Isoniazid 300 mg tablets
      • Rifampin capsules
      • Rifampin injection
    • Antiparasitic drugs:
      • Primaquine
    • Antiviral drugs: 
      • Oseltamivir capsules, powder for oral suspension
    • Vaccines:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Quinupristin-Dalfopristin (discontinued by Pfizer in early 2022, no other supplier)
    • 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)
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