Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Under what circumstance would you order dalbavancin instead of vancomycin or daptomycin for MRSA endocarditis?
The short answer is active/recent IV drug use. Personally, I don’t or didn’t agree with not using PICC and 6 weeks of daily IV abx. My understanding, although it may be outdated, is that there is evidence that most patients would not abuse the PICC. That had been my experience, I had only one patien...
Do you routinely use two empiric antibiotics to cover for Pseudomonas aeruginosa in the management of CF exacerbations?
Historically, two antibiotics have been used to cover Pseudomonas pulmonary exacerbations. The last guidelines were published in 2009 (Flume et al., PMID 19729669 ). At that time, the expert guidelines stated, "The CF Foundation concludes that there is insufficient evidence to recommend the use of a...
Has your approach to direct-from-blood bacterial testing changed after a pragmatic RCT showed no reduction in antibiotic duration compared to blood cultures alone?
No. As an ID practitioner and steward, I am using the data provided by the rapid diagnostics to target therapy as quickly as possible and minimize unnecessary broad abx as possible. As summarized by Banerjee et al., PMID 26197846, and as cited in this paper, active stewardship with audit/feedback is...
How do you advise using Mycoplasma antibody testing to guide antibiotic selection in patients with pneumonia?
I do not. It takes several days to result, and I would not change treatment duration or choice of antibiotic based on a result. I treat all patients with pneumonia with a cell wall inhibitor like amoxicillin and something for atypical coverage like azithromycin. In patients with community-acquired p...
Would you use oral cefixime as an alternative treatment for early syphilis in cases of benzathine penicillin G shortages?
Based on in vitro activity against T. pallidum and the study you cite, cefixime 400 mg BID for 14 days likely is effective for treatment of early syphilis (Klementová et al., PMID 40795115). However, I see no advantage over the recommended option of doxycycline (100 mg BID for 14 days) when BPG isn'...
Is there a role for suppressive antibiotic therapy when it comes to chronic femoral/tibial osteomyelitis?
Suppressive antibiotic therapy would be considered if there is felt to be a nidus that cannot be removed. For example, if a patient has hardware in place that is infected with associated osteomyelitis, but is not a candidate for surgery due to advanced age perhaps. This patient can be considered for...
All things being equal, what patient factors are you looking at in the selection of TAF or TDF in the management of hepatitis B?
If renal function is normal and bone density is not a concern, TDF is much less expensive and has excellent long-term safety.
What clinical criteria do you use to decide whether to continue intravenous gentamicin or fluoroquinolone for the full duration of treatment or to step down to oral therapy in hospitalized patients with tularemia?
There are no prospective, controlled trials for the treatment of tularemia. I am comfortable in treating mild-moderate infections with a PO quinolone. In severe infections (meningitis, endocarditis, extensive pneumonia, etc.), I would definitely start parenterally and step down to an oral regimen wh...
Do you add adjunctive gentamicin and/or rifampin for treatment of prosthetic valve Staphylococcus aureus endocarditis?
No, we do not add adjunctive gentamicin for treatment of Staphylococcus aureus (SA) prosthetic valve endocarditis (PVE). The potential benefit of using an aminoglycoside in this setting is minimal, if any, and is outweighed by the risk of toxicity.With respect to using rifampin, it depends on whethe...
Do you routinely treat patients with neurosyphilis with IM penicillin for 1-3 weeks after completing a full treatment course of IV penicillin?
The same question was asked almost exactly two years ago. Repeating the same reply with minor edits: This has been a topic of a debate among syphilis experts for decades. There are no data at all on whether there is benefit (e.g. in preventing later relapse) in adding low-dose but long-acting penici...