Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
After a course of treatment for neurosyphilis, do you administer an additional IM dose of penicillin G one week after finishing the course of IV penicillin therapy?
Excellent question. This has been the topic of a never-ending (if somewhat behind-the-scenes) debate among syphilis experts for decades. In fact, it came up for discussion just a few days ago after a presentation on syphilis at IDWeek in Boston, the Infectious Disease Society of America's annual con...
When would you add a third antibacterial agent in addition to macrolide and ethambutol for treatment of a patient with HIV and disseminated MAC?
Add 3rd agent for patients failing or not on ART regimen when diagnosed with disseminated MAC Optimize failing ART. For treatment-naïve or not on ART, start ART ASAP after MAC therapy All our samples are sent to National Jewish Health in Denver, CO, right away for drug resistance testing If no clin...
What is your approach to monitoring blood parasite smears in an immunocompetent patient with babesiosis?
In an immunocompetent person the response rate to the treatment of acute babesiosis is extremely high and if a person is clinically improving follow-up smears are probably unnecessary. However, I generally check one at 48 hours to confirm a decrease in parasite burden. If that is favorable and the p...
Do you administer prophylactic antibiotics to prevent VAP following intubation in patients with acute brain injury?
I currently do not, though this trial is interesting and the results are compelling. I think the risk of one dose of CTX is low. No clear evidence of resistance. I think moving forward, I would have a low threshold for administering one dose of ceftriaxone following intubation in my TBI patients. Ho...
What is the antifungal prophylaxis regimen that you use in patients on peritoneal dialysis who are receiving antibiotics?
Data indicates that either nystatin (500,000 U qid) or fluconazole (200 mg q48 hours) is effective in minimizing the risk of fungal peritonitis in PD patients being treated with antibiotics. See the most recent ISPD guidelines (Kam-Tao Li et al., PMID 35264029) for details. As there is less risk of ...
Do you typically adjust or hold immunosuppression in a well-controlled RA patient who is being treated for Mycobacterium avium-intracellulare (MAI)?
It depends on the RA activity and shared decision-making with the patient. A lot of these patients are at risk of MAI infection due to their underlying immunosuppression and on higher levels of immunosuppression because they have more severe rheumatoid disease process. Very often it is difficult for...
Under what circumstances would you recommend the maternal RSV vaccine for a pregnant patient if nirsevimab will also be available for the infant after birth?
All mothers unless there is a specific contraindication to it.
Is there a role for secondary CMV prophylaxis in solid organ transplant patients?
I do not think that secondary prophylaxis (SP) should be used routinely in solid organ transplant patients (SOTPs) after an episode of CMV disease. There is a fairly good retrospective study of SP with Valganciclovir (VGCV) that found no real benefit (Gardiner et al., PMID 29020220). There are some ...
Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?
Compared to NVE, PVE is associated with high morbidity and in-hospital mortality (10-30%). Patients with PVIE who are medically managed have either no surgical indication or have surgical contraindications. 2023 ESC guidelines supported repeating the blood cultures within the first week of finishing...
Is there any role for additional antiviral therapy during rebound from COVID-19 infection after a course of Paxlovid?
Guidelines treat rebound mostly as an infection control issue requiring additional isolation. Treatment is not routinely recommended. Anecdotally, both in the literature and in my practice, I have encountered patients, mostly immunocompromised hosts with severe or very symptomatic rebounds who have ...