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January '24 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Jan 9th 2024

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board and our AMS Program Manager. Links marked with a * are available to Sanford Guide Web Edition and All Access clients. All other links are available without a Sanford Guide subscription. To receive monthly updates via email, sign up now. 

JANUARY 2024

SARS-CoV-2 / COVID-19

Something New: Doxy-PEP

  • Doxycycline* post-exposure prophylaxis (doxy-PEP) has been shown to reduce the incidence of gonorrhea, syphilis, and Chlamydia among cisgender MSM and transgender women who have had at least one of these STIs in the past 12 months (N Engl J Med 2023;388:1296-1306). It can be considered for such persons who have not had a recent STI but are at risk because of multiple partners. Doxy-PEP was not effective in a study conducted in cisgender women (N Engl J Med 2023;389:2331-2340), so more studies regarding its use after vaginal sex are needed. There are no data available for heterosexual, cisgender men who are at risk of STIs, nor for transgender men. Possible long-term effects of doxy-PEP include its potential impact on antibiotic resistance and alterations in the microbiome. The recommended dose of doxycycline (hyclate or monohydrate) is 200 mg orally administered within 24-72 hours of condomless sex.

AMS Pearl: Pediatric AMS & Transitions of Care

  • A single-center study conducted in 2021 at a tertiary referral children’s hospital evaluated factors associated with suboptimal discharge prescribing for antimicrobials. Of the over 2,500 prescriptions for antibiotics, nearly 20% were suboptimal in either choice of drug, duration, dose, formulation-dose mismatch, or dosing frequency.
  • The most common issue identified was prolonged duration of therapy. The reasons for suboptimal prescribing differed based on agent prescribed, indication of therapy, and service of the prescriber. Antimicrobials prescribed for perioperative prophylaxis had the highest rate of suboptimal prescribing.
  • Antimicrobial stewardship programs could use the findings from this study to enhance stewardship efforts at the point of discharge with a focus on antimicrobials prescribed for perioperative prophylaxis. Antimicrob Steward Healthc Epidemiol. 2023;3(1): e223

Drug Shortages (US)

  • Bicillin-LA and Bicillin-CR availability: See Dear Healthcare Professional letter here.
  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of January 8, 2024) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
    • New shortages since December 8, 2023:
      • None
    • Shortage recently resolved:
      • Isoniazid injection, 100 mg/mL (9/23/2023)
      • Neomycin 500 mg tablets (9/7/2023)
      • Tedizolid injection (10/2/2023)
      • Tedizolid phosphate 200 mg tablets (10/2/2023)
    • Antibacterial drugs:
      • Aminoglycosides:
        • Amikacin injection
        • Gentamicin injection (02/22/2021)
        • Tobramycin injection
      • Bacitracin ophthalmic ointment (unavailable)
      • Carbapenems:
        • Meropenem injection
      • Cephalosporins:
        • Cefazolin injection (6/4/2018)
        • Cefdinir, all oral formulations (6/29/2023)
        • Cefixime 400 mg capsules (1/21/2022)
        • 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).
      • Chloramphenicol injection (10/9/2023)
      • Clindamycin phosphate injection (6/25/2015)
      • Doxycycline oral suspension (11/16/2021)
      • Fluoroquinolones:
        • Ciprofloxacin injection (1/13/2023)
        • Ciprofloxacin 0.3% ophthalmic solution
        • Levofloxacin oral solution, 25 mg/mL (9/15/2023)
        • Moxifloxacin 400 mg tablets (12/6/2023)
        • Ofloxacin 0.3% ophthalmic solution
      • Glycopeptides, glycolipopeptides, lipopeptides:
        • Vancomycin injection (6/1/2015)
      • Macrolides/azalides:
        • Azithromycin ophthalmic solution 1% (unavailable)
        • Erythromycin 0.5% ophthalmic ointment (7/8/2022)
      • Metronidazole injection (10/20/2021)
      • Neomycin and Polymyxin B Sulfates GU Irrigant
      • Nitrofurantoin oral suspension
      • Penicillins:
        • Amoxicillin. all oral formulations (10/18/2022)
        • Amoxicillin-clavulanate, all oral formulations
        • Ampicillin injection (10/19/2023)
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Penicillin G benzathine injection (Bicillin-LA) (2/1/2023)
        • Penicillin G benzathine/Penicillin G procaine (Bicillin-CR) (3/31/2023)
        • Penicillin VK tablets (250 mg, 500 mg), oral solution (250 mg/5 mL) (5/17/2023)
        • Piperacillin-tazobactam injection
      • Polymyxin B sulfate/Trimethoprim sulfate ophthalmic solution (03/31/2023)
      • Sulfacetamide 10%/Prednisolone sodium phos 0.23% oph soln (9/21/2023)
      • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs: 
      • Amphotericin B injection (10/10/2022)
      • Amphotericin B Lipid Complex
      • Nystatin topical powder (08/18/2023)
    • Antimycobacterial drugs: 
      • Isoniazid 100 mg, 300 mg tablets
      • Rifampin capsules
    • Antiparasitic drugs:
      • Primaquine
    • Antiviral drugs: 
      • Nirsevimab-alip injection (10/24/2023)
      • Oseltamivir capsules, powder for oral suspension (11/01/2022)
      • Podofilox 0.5% topical gel
      • Ribavirin for inhalation solution
      • Valganciclovir tablets, powder for oral solution
    • Vaccines:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Posaconazole oral susp 40 mg/mL (December 2023, by Merck)
    • Sulfacetamide 10%/Prednisolone acetate 0.2% oph ointment (Aug 2023 by Allergan, sole supplier)
    • Penicillin G procaine 600,000 units/mL IM injection (June 2023)
    • Ritonavir oral solution 80 mg/mL (January 2023)
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