Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you routinely use cefdinir for the treatment of common infections diagnosed in the outpatient setting such as CAP, uncomplicated UTIs?
Not routinely. More expensive than equally effective alternatives.
What is your preferred method for latent tuberculosis screening prior to outpatient hemodialysis initiation for a patient with new dialysis requirements?
Definitely Quantiferon testing. It can be done at the same time as the hepatitis B blood test. The patient does not have to come back and have it read a couple of days later.
Do you have to extend treatment for acute Lyme disease if a patient is on high dose steroids for another indication?
I am unaware of any evidence to support longer-term therapy in such a setting. I am quite sure no such study has ever been done. Standard therapy for early Lyme disease is 10 days of appropriate antibiotics. Extending to 20 days would likely do no harm to the patient, but may not be necessary, and t...
How do you approach PJP prophylaxis in patients with rheumatic disease on corticosteroids?
Here is a graphic I made covering PJP Prophylaxis with Dr. @Dr. First Last if anyone is interested! As noted, one can check absolute lymphocyte count (ALC) or CD4 count as factors to further risk stratify as well.
Do you routinely treat pregnant patients for latent tuberculosis or delay treatment until 2-3 months post-partum?
Guidelines from CDC, WHO, ATS/IDSA recommend delaying the treatment of latent TB in pregnancy until 2-3 months postpartum unless there is a high risk of progression to TB disease e.g. HIV co-infection. This is because the risk of hepatotoxicity from isoniazid is higher during pregnancy and in the ea...
Do you favor a certain NRTI to pair with dolutegravir and lamivudine in persons with HIV to minimize the risk of resistance to dolutegravir?
The data are strong to support DTG/lamivudine as a stand-alone regimen with low risk of resistance development as long as patients remain adherent, so there isn't necessarily a reason to add another NRTI. That said, the Beck et al., PMID 40898778 study would suggest that tenofovir is associated with...
What oral treatment options would you offer a patient with severe onychomycosis who is also on methotrexate for another condition?
I prefer pulsed terbinafine at 250 mg daily x1 week every other month. Dr. Zaias showed in a comparative study that pulsed terbinafine works as well as giving it daily for 3 months, and since the patient is only taking this for 1 week every other month, risks for hepatotoxicity are minimal.
What further evaluation do you pursue for patients who present with vague symptoms such as subjective fevers or intermittent night sweats, who have no pulmonary symptoms but have a positive IGRA?
Great question. Another scenario that is not uncommon is some degree of cough, sometimes for long periods of time, but no other symptoms. If their risk is higher for progression to active disease (e.g., immunocompromised; recent contact with an active case) I may do more than if the risk is low. My ...
Do you treat non-albicans strains of Candida on sputum culture or BAL in patients who are immunosuppressed?
I agree with these answers and do not treat either without biopsy.
Do you ever favor cefazolin over ceftriaxone for bacteremia with susceptible E. coli?
We do cefazolin often unless h/o ESBL or complicated infection or procedural history. It is our preferred abx for pyelo or intra-abdominal infection (we add Flagyl for intra-abdominal) and is driven by our local susceptibility data.