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October '24 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Oct 8th 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 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.

Aztreonam-Avibactam approved in Europe

  • Aztreonam-avibactam* is a new monobactam / β-lactamase inhibitor combination. It was approved by the European Commission on 22 April 2024 for these indications in adults:
    • Complicated intraabdominal infection (± metronidazole)
    • HAP/VAP
    • Complicated UTI including pyelonephritis
    • Infections caused by aerobic gram-negative organisms in patients with limited treatment options
  • Aztreonam* is a monobactam β-lactam that is active against many Enterobacterales, P. aeruginosa, and other gram-negative organisms. It has no useful activity vs anaerobes or gram-positive organisms. It is generally stable to hydrolysis by Ambler class B enzymes (metallo-β-lactamases).
  • Avibactam is a non-β-lactam, β-lactamase inhibitor. It inhibits Ambler class A and class C β-lactamases and some class D enzymes, including ESBLs, KPC and OXA-48 carbapenemases, and AmpC. Avibactam does not inhibit class B enzymes, and it is not able to inhibit many class D enzymes.
  • The recommended dosage in normal renal function is 2 gm/0.67 gm (aztreonam-avibactam) IV load, then 1.5 gm/0.5 gm IV q6h. Doses are to be infused over three hours. The recommended duration of treatment is 5-14 days depending on the indication.

CDC COVID-19 Vaccine Recommendations, 2024-2025

Emergency Use Instructions for Oseltamivir

  • On 19 July 2024, CDC issued Emergency Use Instructions (EUI) for oseltamivir* for treatment or post-exposure prophylaxis (PEP) of pandemic influenza A viruses and novel influenza A viruses with pandemic potential. EUI provide information about emergency use of FDA-approved medical products that differ from or go beyond what is in the FDA-approved product labeling. Information on the following is provided in this EUI:
    • Initiation of oseltamivir treatment after 48 hours from symptom onset.
    • Treatment of severely ill hospitalized patients, including longer courses of treatment (e.g., 10 days), based on clinical judgment.
    • Higher total daily dose and flexible duration for PEP. The EUI-recommended dosing regimen in most cases is twice daily for 5 or 10 days in asymptomatic close contacts of a confirmed or probable novel influenza A case or asymptomatic persons exposed to animals infected with highly pathogenic avian influenza A(H5N1) virus or other novel influenza A viruses.
    • Treatment of term neonates under 2 weeks of age.
    • PEP in neonates and infants less than 1 year of age.
    • Treatment and PEP dosing regimens for preterm neonates and infants.
  • Useful links:

Fexinidazole and HAT

  • New 2024 WHO Guidelines for human African trypanosomiasis (HAT) establish oral treatment with fexinidazole* (available in the US from Sanofi) as first-line against both East African* and West African* strains, no matter the disease stage. US CDC is in the process of updating their online materials to correspond.

AMS Pearl: Global Antimicrobial Resistance Threat

  • A paper published ahead of the United Nations General Assembly High-Level Meeting on Antimicrobial Resistance (AMR) highlights the current burden of AMR across regions and provides a forecast for the future.
  • The study estimated that 4.71 million deaths were associated with bacterial AMR in 2021. While deaths from AMR decreased among children younger than 5 years, deaths increased by over 80% for adults 70 years and older from 1990-2021. During the same time period, deaths associated with and attributable to methicillin-resistant Staphylococcus aureus increased the most across the globe.
  • In the future, an estimated 1.91 million deaths attributable to AMR and 8.22 associated with AMR could occur globally in 2050.
  • Antimicrobial stewardship (AMS) programs can use the data from this study to seek financial support to strengthen efforts around optimizing antibiotic use, reducing antibiotic overuse, and educating patients and healthcare professionals about AMS. Lancet. 2024;404(10459):1199-1226. doi:10.1016/S0140-6736(24)01867-1

Antimicrobial Shortages (US)

  • New shortages:
    • None
  • Resolved shortages:
    • Isoniazid injection 100 mg/mL (15 Aug 2024)
    • Valganciclovir powder for oral solution (12 Sep 2024)
    • Valganciclovir 450 mg tablets (12 Sep 2024)
  • Antimicrobial drugs or vaccines in continued reduced supply or unavailable (as of 6 October 2024) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • Antibacterial drugs:
      • Aminoglycosides:
        • Gentamicin injection (22 Feb 2021)
      • Bacitracin ophthalmic ointment 500 units/gm (12 Sep 2024)
      • 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)
      • 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)
      • Fluconazole injection (9 Aug 2024)
      • Nystatin oral suspension (21 June 2024)
    • Antimycobacterial drugs:
      • Isoniazid 100 mg, 300 mg tablets (1 Sep 2022)
    • Antiparasitic drugs:
      • Mefloquine 250 mg tablets (14 May 2024)
      • 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)
  • 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)
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