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September '24 Infectious Diseases Update

Posted by Doug Black, PharmD., Ann Lloyd, PharmD. on Sep 18th 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.

From CDC

  • Clinical guidance for the newly approved 21-valent pneumococcal conjugate vaccine (PCV21)*. PCV21 contains eight serotypes not included in other licensed vaccines. On June 27, 2024, ACIP recommended a single dose of PCV21 as an option for adults aged ≥19 years for whom a pneumococcal conjugate vaccine (PCV) is currently recommended. Indications for PCV have not changed from previous recommendations (MMWR 2024;73:793-798). PDF of full report available here.

Global Guideline for Cryptococcosis

  • Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM (Lancet Infect Dis 2024;24:e495-512). More than 70 societies internationally have endorsed the content, structure, evidence, recommendation, and pragmatic wisdom of this global cryptococcosis guideline. For induction therapy of cryptococcal meningitis, disseminated cryptococcosis, and severe isolated pulmonary cryptococcosis in high-income settings, the guideline recommends two weeks of liposomal amphotericin B* (3–4 mg/kg IV q24h) plus flucytosine* 25 mg/kg po q6h. For induction therapy of HIV-associated cryptococcal meningitis in low-income settings, the guideline suggests liposomal amphotericin B 10 mg/kg IV as a single dose with two weeks of flucytosine 25 mg/kg po q6h plus fluconazole* 1200 mg q24h (note: this regimen has not been trialed in non-HIV-associated cryptococcal meningitis or other non-CNS cryptococcosis syndromes). PDF of guidelines available here (must register for free access).

Updated SIS Guidelines

  • The Surgical Infection Society (SIS) has published its 2024 evidence-based guideline update on the management of intraabdominal infection* in adults. Previous versions were published in 1992, 2002, 2010, and 2017 (Surg Infect 2024;25:419-435). PDF of guidelines available here.

AMS Pearl: Guideline for Antimicrobial Stewardship in Emergency Departments

  • A new guideline from the European Society of Clinical Microbiology and Infectious Diseases endorsed by the European Association of Hospital Pharmacists provides recommendations for highly effective antimicrobial stewardship (AMS) practices for emergency departments (EDs) caring for adult patients.
  • The guideline focuses on four areas where guidance is lacking or controversial: rapid pathogen tests and biomarkers, blood culture collection, watchful waiting/withholding antibiotic treatment, and structured culture follow-up. Included with the recommendations are implementation strategies and suggestions for overcoming barriers.
  • AMS programs looking to start or expand stewardship efforts in the ED may find the recommendations and strategies in this guideline useful. Clin Microbiol Infect. Published online July 17, 2024. doi:10.1016/j.cmi.2024.05.014

Antimicrobial Shortages (US)

  • New shortages:
    • Bacitracin ophthalmic ointment 500 units/gm (12 Sep 2024)
  • 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 16 September 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)
      • 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:
      • 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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