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June '23 Infectious Disease Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD on Jun 15th 2023

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. 

 

JUNE 2023

CDC NARMS Data Available in Sanford Guide App

  • Sanford Guide recently collaborated with the Centers with Disease Control and Prevention to provide convenient access to data collected by the National Antimicrobial Resistance Monitoring System through the Sanford Guide mobile app and web platform. Data are presented in a familiar antibiogram format, alongside a concise metadata document explaining how the data can be interpreted, and with links to other helpful resources from the CDC.
  • CDC data can be added for free through the "Add-Ons" menu in the Sanford Guide app. This collaboration builds upon Sanford Guide's ongoing effort to partner with public health agencies to make public health data more accessible.

SARS-CoV-2 / COVID-19

US FDA Drug Approvals

  • A co-packaged product containing nirmatrelvir and ritonavir tablets (Paxlovid*) for the treatment of mild-to-moderate COVID-19 in adults who are at high risk for progression to severe disease, including hospitalization or death. Drug manufactured and packaged under the EUA and distributed by DHHS will continue to be available to ensure continued access for adults, as well as treatment of eligible children ages 12-18 who are not covered by the approval. Paxlovid is not approved or authorized for use as a pre-exposure or post-exposure prophylaxis for prevention of COVID-19. See FDA news release here.
  • A co-packaged product containing injectable sulbactam and durlobactam (Xacduro*), for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) caused by susceptible isolates of Acinetobacter baumannii-calcoaceticus complex in patients ≥18 years of age. Sulbactam is a beta-lactamase inhibitor with intrinsic activity against Acinetobacter baumannii; durlobactam is a beta-lactamase inhibitor which helps to prevent degradation of sulbactam by enzymes produced by A. baumannii. Recommended dosage in normal renal function is 1 gm of sulbactam and 1 gm of durlobactam IV q6h (infused over three hours). The co-packaged product was granted Priority Review and designated as a Qualified Infectious Disease Product (QIDP). Availability is expected later this year. See FDA news release here.
  • A second respiratory syncytial virus (RSV) vaccine (Abrysvo) has been approved for use in individuals 60 years of age and older. This unadjuvanted, bivalent vaccine is composed of equal amounts of recombinant RSV prefusion F protein from RSV subgroups A and B. Dosage is a single 0.5 mL injection. The vaccine will not be released until fall.

AMS Pearl - Clinical Decision Support in Outpatient Settings

  • A recently published study found that implementing clinical decision support tools in the electronic health record was associated with a decrease in antibiotic prescribing. The tools were programmed to trigger when azithromycin or fluoroquinolones were ordered in the emergency department and outpatient clinics of a single institution. In both the emergency department and outpatient clients, monthly rates of azithromycin prescribing decreased significantly (-24% and -47%, respectively). In the clinics, there was no significant drop in the immediate period for ciprofloxacin, but over time, there was a significant decrease (-%5 per month).  
  • Antimicrobial stewardship programs could use the findings from this study to support implementation of clinical decision support tools in emergency departments and outpatient clinics. Antimicrob Steward Healthc Epidemiol. 2023 Apr 26;3(1):e80.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of June 12, 2023) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
    • New shortages since May 5, 2023:
      • Isoniazid injection (100 mg/mL)
      • Penicillin VK tablets (250 mg, 500 mg; 250 mg/5 mL oral solution
      • Ribavirin inhalation powder for solution
    • Shortage recently resolved:
      • Clotrimazole 10 mg oral troches
      • Rifampin injection
      • Rifapentine 150 mg tablets
      • Rifaximin tablets (200 mg, 550 mg)
    • 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),
      • Clindamycin injection
      • Doxycycline oral suspension
      • Fluoroquinolones:
        • Ciprofloxacin injection
        • 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 oral formulations)
        • Dicloxacillin capsules (250 mg, 500 mg)
        • Penicillin G benzathine injection
        • Penicillin G benzathine/Penicillin G procaine (Bicillin)
        • Piperacillin-tazobactam injection
      • Polymyxin B sulfate/Trimethoprim sulfate ophthalmic solution
      • Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment (unavailable)
      • Sulfanilamide 15% vaginal cream (unavailable)
    • Antifungal drugs: 
      • Amphotericin B injection
      • Amphotericin B Lipid Complex (ABLC)
    • Antimycobacterial drugs: 
      • Isoniazid 100 mg, 300 mg tablets
      • Rifampin capsules
    • Antiparasitic drugs:
      • Primaquine
    • Antiviral drugs: 
      • Oseltamivir capsules, powder for oral suspension
      • Valganciclovir tablets, powder for oral solution
    • Vaccines:
      • None
  • Antimicrobial drugs recently discontinued: 
    • Ritonavir oral solution 80 mg/mL (January 2023)
    • 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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