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Feb '23 Infectious Disease Update

Feb 14th 2023

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. 

February 2023 

COVID-19

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

  • January 26: The US FDA revises the EUA for Tixagevimab + Cilgavimab (Evusheld) to limit its use to when the combined frequency of non-susceptible SARS-CoV-2 variants nationally is ≤90%. Based on this revision, Evusheld is not currently authorized for use in the US until further notice. Click here for more information.
  • COVID-19 vaccination in cancer patients: 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.

US ACIP Recommended Immunization Schedules, 2023

Updated HHS HIV/AIDS Practice Guidelines

Other New or Updated Practice Guidelines

Antimicrobial Stewardship Pearl

  • Nearly 10% of patients report a history of penicillin reaction while greater than 90% of these patients tolerate penicillins.  Patients with a penicillin allergy label are more likely to be treated with broad spectrum antibiotics putting them at risk for Clostridioides difficile and other adverse outcomes. Assessing penicillin allergies is one of the example actions to improve antibiotic use in the Centers for Disease Control and Prevention Core Elements of Hospital Antibiotic Stewardship Programs.  
  • Gathering and evaluating allergy histories spans the continuum of care, and nurses, prescribers, and pharmacists each have a role in the process. In the second half of 2022, the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology published Drug Allergy 2022: A Practice Parameter Update. This update includes recommendations for diagnosis and management of drug allergies including a section regarding antibiotic allergies. The document contains information about de-labeling, skin testing, penicillin challenges, side chain comparison charts and tables, and algorithms. Facilities could use this guidance to develop or optimize beta-lactam allergy pathways to improve antibiotic use and stewardship outcomes.  

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of February 10, 2023) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
    • New shortages since January 8, 2023:
      • Benzathine penicillin G injection
      • Ciprofloxacin injection
      • Valganciclovir tablets, oral powder for solution
    • Shortage recently resolved:
      • Dalbavancin injection
      • 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
        • Ofloxacin 0.3% ophthalmic solution
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection
      • Macrolides/azalides:
        • Azithromycin injection
        • Azithromycin ophthalmic solution 1% (unavailable)
        • Erythromycin 0.5% ophthalmic ointment
      • Metronidazole injection
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Amoxicillin (all oral formulations)
        • Amoxicillin-clavulanate (all formulations)
        • Ampicillin-sulbactam injection
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Piperacillin-tazobactam injection
      • Rifaximin 200 mg tablets
      • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
      • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs: 
      • Amphotericin B injection
      • Amphotericin B Lipid Complex (ABLC)
      • Clotrimazole 10 mg oral troches
    • Antimycobacterial drugs: 
      • Isoniazid 300 mg tablets
      • Rifampin capsules
      • Rifampin injection
      • Rifapentine 150 mg tablets
    • Antiparasitic drugs:
      • Primaquine
    • Antiviral drugs: 
      • Oseltamivir capsules, powder for oral suspension
    • Vaccines:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Lindane 1% shampoo (discontinued by Wockhardt USA in June 2022, no other supplier)
    • 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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