July '24 Infectious Diseases Update

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 All Access & Sanford Guide for Web clients. All other links are available without a Sanford Guide subscription. To receive monthly updates via email, sign up now.

JULY 2024

COVID-19 Vaccine

• CDC has officially recommended that everyone ≥6 months of age, whether or not they have ever previously been vaccinated with a COVID-19 vaccine, receive an updated 2024-25 vaccine this fall.
• Detailed guidelines will be published as soon as the new vaccines are available. Antigenic composition:
  • KP.2 for Moderna and Pfizer mRNA vaccine.
  • JN.1 for Novavax recombinant protein vaccine (not approved for age <12 years).
• The current 2023-2024 vaccine formulation and guidelines should be followed until then.

RSV Vaccine

• As of June 2024, three RSV vaccines (Arexvy [GSK], Abrysvo [Pfizer], mRESVIA [Moderna]) are FDA-approved, with ACIP guidelines in place.
  • In clinical trials, vaccine effectiveness (VE) of a single dose in the first and second year against severe outpatient disease were, respectively, Abrysvo 86% and 74%, Arexvy 79% and 59%, and mRESVIA 55% and 36%.
  • Real-world observational data for hospitalization from US hospitals during winter 2023-24 showed:
    • For both Arexvy and Abrysvo, VE was approximately 80% against RSV-associated hospitalization, ED visits and critical illness.
    • mRESVIA was unavailable during winter 2023-24.
  • Excess cases of Guillain-Barre Syndrome are seen with Abrysvo and, to a lesser extent, Arexvy, but so far not with mRESVIA.
  • Risk-benefit analysis is vastly in favor of vaccination per these indications:
    • All adults >75 years of age.
    • Adults 60–74 years of age with certain chronic medical conditions or other factors that increase risk of severe RSV disease.
    • NOT recommended for adults 60–74 years of age who are not at increased risk of severe RSV.

AMS Pearl: Antimicrobial Stewardship in Neonates

• A recently published systematic review and meta-analysis of 70 studies evaluated the effectiveness of antimicrobial stewardship (AMS) in neonates admitted to neonatal intensive care units (NICU) or postnatal wards.
• Moderate-certainty evidence suggests that after AMS intervention, there was a significant reduction in the initiation of antimicrobial agents and duration of therapy across the included studies. There was low-certainty evidence for a reduction in drug resistance, cost, and sustainability of AMS with no increase in rates of antimicrobial reinitiation or sepsis-related mortality.
• Antimicrobial stewardship teams can use the findings from this study to expand efforts in the neonatal population. Pediatrics. 2024;153(6):e2023065091. doi:10.1542/peds.2023-065091

Antimicrobial Shortages (US)

• New shortages:
  • Nystatin oral suspension (21 June 2024)
• Shortages recently resolved:
  • Amphotericin B injection (6 July 2024)
• Antimicrobial drugs or vaccines in continued reduced supply or unavailable (as of 7 July 2024) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
  • Antibacterial drugs:
    • Aminoglycosides:
      • Gentamicin injection (22 Feb 2021)
    • Cephalosporins:
      • Cefazolin injection (4 Jun 2018)
      • Cefdinir 300 mg capsules (29 Jun 2023)
      • Cefdinir 125 mg/5 mL, 250 mg/5 mL oral suspension (29 Jun 2023)
      • Cefotaxime injection (10 Jun 2015)
        • 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 (9 Oct 2023)
    • Clindamycin phosphate injection (25 Jun 2015)
    • Fluoroquinolones:
      • Ciprofloxacin injection (13 Jan 2023)
      • Levofloxacin injection in D5W (29 May 2024)
      • Levofloxacin oral solution, 25 mg/mL (15 Sep 2023)
      • Moxifloxacin 400 mg tablets (6 Dec 2023)
      • Ofloxacin 0.3% ophthalmic solution (22 Dec 2022)
    • Glycopeptides, glycolipopeptides, lipopeptides:
      • Vancomycin injection (1 Jun 2015)
    • Macrolides/azalides:
      • Erythromycin 0.5% ophthalmic ointment (8 Jul 2022)
    • Metronidazole injection (20 Oct 2021)
    • Neomycin and Polymyxin B Sulfates GU Irrigant (25 Jun 2023)
    • Nitrofurantoin oral suspension (5 Jun 2018)
    • Penicillins:
      • Amoxicillin, all oral formulations (18 Oct 2022)
      • Amoxicillin-clavulanate, all oral formulations (17 Nov 2022)
      • Ampicillin injection (19 Oct 2023)
      • Dicloxacillin 250 mg, 500 mg capsules (18 Aug 2021)
      • Nafcillin injection (20 Mar 2024)
      • Penicillin G benzathine injection (1 Feb 2023) Availability update here
      • Penicillin G benzathine/Penicillin G procaine (31 Mar 2023) Availability update here
      • Penicillin VK oral solution 250 mg/5 mL (17 May 2023)
      • Penicillin VK 250 mg, 500 mg tablets (17 May 2023)
    • Polymyxin B sulfate/Trimethoprim sulfate ophthalmic solution (31 Mar 2023)
    • Rifaximin 200 mg tablets (11 Apr 2024)
  • Antifungal drugs:
    • Amphotericin B Lipid Complex (5 Aug 2022)
  • Antimycobacterial drugs:
    • Isoniazid 100 mg, 300 mg tablets (1 Sep 2022)
    • Isoniazid injection 100 mg/mL (24 Jan 2024)
  • Antiparasitic drugs:
    • Nitazoxanide oral susp 100 mg/5 mL (15 Feb 2024)
  • Antiviral drugs:
    • Acyclovir injection (21 Feb 2024)
    • Oseltamivir 30 mg, 45 mg, 75 mg capsules (1 Nov 2022)
    • Oseltamivir powder for oral suspension (1 Nov 2022)
    • Ribavirin for inhalation solution (23 May 2023)
    • Valganciclovir powder for oral solution (7 Feb 2023)
    • Valganciclovir 450 mg tablets (7 Feb 2023)

• Antimicrobial drugs recently discontinued:
  • Posaconazole oral susp 40 mg/mL (Dec 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 (Jun 2023)
  • Ritonavir oral solution 80 mg/mL (Jan 2023)

• For more detailed information including estimated resupply dates, see https://www.ashp.org/Drug-Shortages/