The FDA has approved an IV formulation of the antifungal drug posaconazole (Noxafil - Merck) for prophylaxis of Aspergillus and Candida infections in adults at high risk for these infections, such as those with prolonged neutropenia. Posaconazole is also available as delayed-release tablets and an oral suspension.With activity against Aspergillus and Candida, posaconazole has an antifungal spectrum similar to that of voriconazole (Vfend, and generics), but unlike voriconazole it is also active against many species of Mucorales (formerly called Zygomycetes), such as Mucor and Rhizopus....

The drugs of choice for treatment of viral infections (other than HIV) and their dosages are listed in Tables 1-6 on the pages that follow. Some of the indications and dosages recommended here have not been approved by the FDA. Vaccines used for the prevention of viral infections are discussed elsewhere.

Recombinate (Baxter) and Kogenate (Miles), two recombinant-DNA-derived Factor VIII (rFVIII) preparations, were recently approved for marketing by the US Food and Drug Administration. Clotting factor concentrates are generally prepared from large plasma pools obtained from thousands of donors. Without adequate inactivation of viruses, these concentrates can transmit hepatitis B, hepatitis C, and the human immunodeficiency virus (HIV), among others. The new recombinant products, which include human albumin added as a stabilizer, are claimed to be free of blood-borne viruses.

Zanamivir, a neuraminidase inhibitor taken by inhalation, has been approved by the FDA for treatment of influenza. Oseltamivir phosphate, an oral neuraminidase inhibitor, will probably be approved soon.

The CDC has issued new guidance allowing for an interval of up to 8 weeks between the first and second primary doses of an mRNA COVID-19 vaccine in certain patients 12-64 years old.1 Product labeling currently recommends a 3-week interval between the first two doses of the Pfizer/BioNTech mRNA vaccine (Comirnaty) and a 4-week interval between the first two doses of the Moderna mRNA vaccine (Spikevax). The new guidance is based on data suggesting that a longer interval can decrease the risk of myocarditis and may improve vaccine efficacy.

View the Expanded Table: Some Vaccines for Travelers

An outbreak (8 cases to date) of meningococcal disease at Princeton University caused by Neisseria meningitidis serogroup B has led the FDA and CDC to permit importation and investigational use (at Princeton University only) of a meningococcus B vaccine (4CMenB; Bexsero – Novartis) that has not been approved in the US. Bexsero has been approved for use in the European Union and in Australia.THE VACCINE — Until recently, no serogroup B vaccine was widely available because the polysaccharide capsule of the B serogroup, unlike those of the other main meningococcal serogroups (A, C, Y, and...

Patients may ask about taking elderberry for prevention and treatment of influenza. Products containing elderberry are promoted for relief of cold and flu symptoms and as an immune system booster.

Sumatriptan (soo ma trip' tan; Imitrex - Glaxo), a serotonin (5-HT) agonist, is now available in Canada and may soon be available in the USA for oral or parenteral treatment of migraine headache. The parenteral formulation is designed for patients to inject themselves subcutaneously. Sumatriptan is not recommended for prophylactic use.

An IV formulation of pantoprazole sodium (Protonix IV - Wyeth-Ayerst), a benzimidazole proton pump inhibitor (PPI), has been approved by the FDA for short-term treatment of Zollinger-Ellison Syndrome (ZES) and gastroesophageal reflux disease (GERD) in patients who cannot take oral drugs. Pantoprazole is the first PPI to be approved for IV use in the US.