Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you routinely recommend transition to dual PO antibiotic coverage for strep species and MRSA, for patients with purulent cellulitis and in the absence of culture data?
I use mostly Linezolid because: It’s now much cheaper. Even if on serotonin drugs, I can half the serotonin dose while they are on it. Covers pretty much all Strep and Staph, including MRSA. Protein synthesis inhibition may reduce toxins (like clinda in Strep fasciitis). There is no renal dose adju...
Under what circumstances would you choose the 1-month 1HP treatment over a 3-4 month regimen for latent TB?
I tend to favor the 1-month daily isoniazid–rifapentine regimen (1HP) in very specific clinical and programmatic contexts, rather than as a default option. Its main advantage is speed i.e. when there is a narrow window to complete latent TB treatment such as prior to imminent immunosuppression (e.g....
What has been your experience with tecovirimat for monkeypox?
I thought it worked well in 2 patients of mine with rectal Mpox. However, the clinical trial did not confirm this, and it was a lot of trouble to get TPOXX going with consent, investigational drug, etc so we have abandoned use here.
Under what circumstances do you recommend use of antibiotics during end-of-life care?
I use antibiotics at the end of life for palliation of pain and suffering after discussion with the hospitalist, family, and patient, if possible.
What is the best alternative oral therapy for treatment of non-severe pulmonary nocardiosis in an immunocompetent patient with sulfa allergy?
We have been using linezolid for this indication, based on a paper from ARUP Labs.Schlaberg et al., PMID 24247124
Do you recommend the use of ampicillin/ceftriaxone for prosthetic valve endocarditis due to ampicillin-susceptible Enterococcus faecium?
The prognosis for Enterococcus faecalis endocarditis is generally better than that for Enterococcus faecium, primarily due to antibiotic susceptibility patterns. It is fortunate to have an ampicillin-susceptible strain of E. faecium in this case of prosthetic valve infective endocarditis. In general...
What is your approach to management of patients with recurrent orolabial herpes?
Recurrent orolabial herpes is fundamentally a disease of viral latency with episodic reactivation, so my approach focuses less on “treating infection” and more on reducing recurrence burden, shortening symptom duration, and improving quality of life. First, I make sure we are actually dealing with H...
In what circumstances would you consider monotherapy for empiric treatment of unresectable nontuberculous mycobacterial lymphadenitis?
NTM lymphadenitis is rather uncommon, and I personally have little experience with it and did not see it much even at NJH. However, extrapolating from how I treat any NTM disease in general, I would shy away from monotherapy in any NTM disease, preferring at least two active agents. Perhaps one scen...
How do you consider sending fungal studies in a patient with pneumonia?
This is a very good question. One that I’ve meant to look up for a while, so thank you for prompting me to do so. I agree with Dr. @Dr. First Last's answer (he is also my division chief!), but wanted to expand further. The articles I found most helpful are cited below.When to suspect a fungal pneumo...
What factors prompt you to treat enterococcus when isolated in polymicrobial culture from patients with urinary tract infection?
Enterococcus is an organism that I would treat when isolated in a clinically significant positive urine culture, even when polymicrobial. Since Enterococcus produces a biofilm, it can essentially trap other organisms in and be seen in the setting of a polymicrobial infection. In this setting, I woul...