How stable is amoxicillin? Can we use it for OPAT? According to a new evidence HERE, it is stable and can be dwelled for up to 12 hours at room temperature when reconstituted at 25mg/mL.
What is the latest evidence in Covid-19 treatment as well as pathophysiology? The link HERE leads you to a collection of recent studies on Covid-19 including steroid therapy by RECOVERY trial as well as the impact of low dose steroids in driving viral shedding (but not high dose regimen)
The review article HERE provides readers with evidence and checklist for oral antibiotic therapy in people who inject drugs with bacteraemia
How do you ensure optimal levels of vancomycin in your patients? To learn more on this, join MAD-ID webinar HERE titled "Implementing the 2020 Vancomycin Guidelines: What every clinician needs to know"
AMR is a threat especially for the low and middle-income countries including Malaysia. Earlier this month, IJID released a review paper on this titled "Global Antimicrobial Stewardship with a Focus on Low- and Middle-Income Countries ". It was co-written by one of our own Antibiotic Ninjas- Dr Syamhanin. Click HERE to read it.
We can all agree that antibiotic de-escalation is a good practice even in ICU. But how often do we do it? Read this paper HERE from a large observational study called DIANA to find out more. It was sourced from 152 ICUs from 28 countries, including 2 centers from Malaysia.
By now, there are many "one-stop" centers for Covid-19-resources out there. One of them is HERE by Epocrates including trial updates, ARDS management guidelines and Covid-19 symptom evaluation.
Wuhan City of China has been hit by a cluster of "PUO"-Pneumonia of unknown origin since December 2019. WHO has released an outbreak news HERE, and to update yourself on infection prevention when comes to epidemic-and pandemic prone acute respiratory infections in health care setting, please click HERE instead.
A single dose of ivermectin is apparently sufficient in treating Strongyloidiasis when compared to four-dose regimen. Please click HERE to read further on this.
Should we add on macrolide or not to beta lactam therapy in CAP management? This data HERE from a large cohort of 5 European countries add to the growing data and debate on macrolide role in CAP management.
Is multi-disciplinary approach the way to go in managing ICU cases suspected of infection? Click HERE for the answer
What are the tell-tale signs of a "bad" GNB bacteraemia? Apparently these are the criteria that predict early clinical failure following its onset. Click HERE to read further.
Late November 2019
Have you submitted your abstract for ECCMID 2020 which will be held in Paris, France next year? The deadline for abstract submission is coming soon: 27 November 2019 at 23:59 CET. Hurry up and do not miss the chance!
How do you treat or manage drug resistant TB? HERE is a new practice guideline from ATS/CDC/ERS/IDSA in treating Drug Resistant Tuberculosis.
Recently, there is an update from CDC on The Core Elements of Hospital Antibiotic Stewardship Programs: 2019. Read it HERE.
Have you heard of the new cephalosporin antibiotic, Cefiderocol? Click HERE to read on the PK/PD profiles of this novel siderophore cephalosporin and find out how is it better than previous cephalosporins.
How would you dose Pip-Tazo in a critically-ill patient with creatinine clearance of 18 ml/min? This paper is a must read on selected antimicrobial dosing in critical care. Click HERE to read further.
Early November 2019
How do clinicians around the world treat pan-drug resistant Gram-negative organisms? Article HERE summarises previous reports on this, including treatment of PDR Ab, whereby some used poly B (IV + inhaled ) + tigecycline + sulbactam.
Paper HERE talks about the clinical outcomes of oral antibiotic therapy in patients with ESBL UTI. Agents such a co-amoxiclav and TMP-SMX were used for this infection.
What do clinicians need to know about penicillin allergy? Paper HERE summaries the basics of PenA, including this useful table on side chain similarity.
Late October 2019
USPSTF has recently graded screening and treatment of asymptomatic bacteriuria in pregnant mothers as moderate only. Click HERE to read the guidelines.
HERE are tips on how to write great science papers by a novelist, Cormac McCarthy. He helped to edit works by several researchers including those from Harvard university.
Does antibiotic receipt really mess with the recovery of bacterial blood culture? Click HERE to find out the answer from this recent multi-center trial conducted in 7 ERs across North America.
Bye bye aminoglycosides for (most) infective endocarditis! Read this interesting paper HERE to know more.
Early October 2019
After a long wait of 12 years, finally American Thoracic Society has updated their documents/guidelines regarding Diagnosis and Treatment of Adults with Community-acquired Pneumonia. Read it HERE for more details.
Would diagnostic sensitivity be affected by administering antimicrobial agents before obtaining blood cultures among patients with severe manifestations of sepsis? Find out more HERE.
This RCT found that prophylactic oral vancomycin appears to protect against health care facility-onset Clostridioides difficile Infection during in-patient stays in targeted patients during systemic antibiotic exposure.
Which antibiotic appears to be better in patients with drug-resistant Pseudomonas aeruginosa? Ceftolozane/Tazobactam vs polymyxin or aminoglycoside-based regimens? Click HERE to find out.
Having difficulty in dosing liposomonal Amphotericin B for morbidly obese patients? This prospective study has the ANSWER.
Want to know how infectious diseases consultation able to decrease 90-day mortality by 19% in patients with candidemia? Click HERE for more details.
Mid September 2019
A new guidelines from American Thoracic Society on the lab testing for fungal infection is currently available HERE for free. These include recommendations on the use of galactomannan, B-DG as well as PCR in daily practice.
New Case Report
Do you know that there is a significant drug-drug interaction between carbapenems and valproic acid? Read THIS case report in which meropenem is used to treat valproic acid overdose in addition to levocarnitine.
You may think that carbapenems are preferred when treating cIAIs (complicated intra-abdominal infections). This systematic review and meta-analysis will tell you otherwise. Read it HERE.
How to optimize the design of research to evaluate antibiotic stewardship interventions? Click HERE to read on the recommendations by a multinational working group.
Any difference in the outcome when choosing Linezolid over glycopeptides (Vancomycin or Teicoplanin) to treat glycopeptide-susceptible Enterococcus faecium bacteremia? This is the LINK to the paper.
This interesting study has shown that TeleASP (ASP implemented via telehealth) in two community hospitals has led to reduced broad-spectrum antimicrobial utilization, increased ID consults, and reduced antimicrobial expenditures. Can we implement this in our district hospitals? Click HERE to read more.
Does Vancomycin increase VRE infection compared to Metronidazole in patients with C. difficile infection? Read on the full paper HERE.
Early September 2019
Can the β-lactamase inhibitor relebactam restore imipenem against imipenem-nonsusceptible gram-negative pathogens? Read this new RCT (RESTORE-IMI 1) HERE to find out more.
Would addition of a beta-lactam to daptomycin provide any benefit in patients with MRSA bloodstream infections? This multicenter retrospective study HERE will enlighten you regarding this matter.
A new multicenter RCT (OASIS 2) concluded that once-daily oral omadacycline was non-inferior to twice-daily oral linezolid in adults with acute bacterial skin and skin structure infections, plus was safe and well tolerated. To read further please click HERE.
Cefazolin versus anti-staphylococal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphyloccoccus auerus Infection: A Meta-Analysis with Trial Sequential Analysis. To read further please click HERE
Is it true that monthly high-dose Vitamin D supplementation will prevent acute respiratory infections in older adults? Click HERE to find out more from this RCT.
Do you still send the tip of catheters for culture? The article HERE argues the importance of such practice.
Society of Infectious Diseases Pharmacists or SIDP has come out with a series of podcast. It covers myriad of topics which includes, ECCMID 2019 rapid review, skin testing for PenA and stewardship as a team sport. Listen to these for free on Spotify HERE or via Apple Podcast HERE.
New Movies on Nipah virus
Dr. Shaharudeen (the new and upcoming ID fellow from Sungai Buloh) shared with me a movie (must watch he said minus those sing-along songs- cos he dislikes songs and dancing it seems) that narrated the Nipah outbreak in India. Click HERE to appraise the movie like Dr Shah. What say you to a movie night people?
There is now a new and updated guidelines on PEP for varicella and shingles from UK. Click HERE to read it.
What is your prophylaxis agent of choice in patients with penicillin allergy undergoing shoulder arthroplasty? Would you use clindamycin or cefazolin or vancomycin? If clindamycin is your choice, the risk for post-op infection is up to 3-4 X higher according to this large study HERE.
What are some of the risk factors for subtherapeutic voriconazole levels in patients receiving this antifungal? Apparently these were younger age and underlying hematological malignancy according to a study HERE. In Malaysia we have yet to have centres that perform TDM for vori. Thus, we should be watchful if vori is given for these types of patient.
Mid July 2019
Click HERE to read on the new CPG from Korean Association for the Study of the Liver (KASL) on Management of Chronic Hepatitis B.
What definitive monotherapy antibiotic do you use for Pseudomonas aeruginosa bloodstream infection? THIS multi-site retrospective study compares the clinical outcomes between a few antipseudomonal antibiotics.
This interesting study addresses the concern of using anti-anaerobe antibiotics such as piperacillin/tazobactam, amoxicillin/clavulanate and metronidazole in critically-ill patients. Read further HERE.
Any difference in the outcome when treating patients with candidemia and septic shock using azoles or echinocandins? Click HERE to read on this study done in 5 tertiary care hospitals in Italy. This study, however, only includes patients admitted to MEDICAL wards.
Does a bundle of evidence-supported treatments (including adjunctive corticosteroids) improve the outcomes of patients with community-acquired pneumonia? This is the question that THIS RCT tries to answer.
Ceftaroline fosamil is frequently being used for off-label indications e.g. in bacteremia or as combination with other antibiotics. A new systematic review study summarizes evidence regarding off-label use of ceftaroline, with regard to safety and efficacy. Read more HERE.
This population PK study showed that high-dose ceftriaxone administration scheme should be adapted to eGFR and the weight for the treatment of bacterial meningitis in adult patients. Read HERE for more details.
Procalcitonin level is NOT a good marker to distinguish viral from bacterial pneumonia. This meta analysis HERE will explain in more details.
Interested to learn about the differences of Sepsis-2 and Sepsis-3 in predicting mortality in critically ill patients? Follow the link HERE.
Cross-Reactivity to Cephalosporins and Carbapanems in Pencillin-Allergic Patients: Two Systematic Reviews and Meta-Analyses. To read further please click HERE.
Early July 2019
Have you heard of acute care beta-lactam allergy pathways?
It is a coordinated allergy assessment program for hospitalized patients that can serve as an important tool in ASP initiative. Click HERE for a CME session on this.
Can we treat patient with UTI who present with less severe symptoms using analgesia (in this case ibuprofen) or leaf extract? Read a recent trial HERE on this to find out more about it.
This short review HERE lists out recent trials and observational data on CRE management, as well as newer agents in the market that could be used against CRE.
What should be one's options against ESBL-producing GNB post MERINO trial? Click HERE to read a new review on this, whereby authors divide ESBL patients into 3 strata with corresponding treatment recommendations.
Carbapenem resistant Acinetobacter baumanii (CRAB) continues to be one of the leading MDR organisms locally. The narrative review HERE succinctly summarize the current data on agents that one can use against CRAB.
Mid June 2019
BHIVA has recently released a new guidelines for the management of tuberculosis in adults living with HIV. Click HERE to read it.
IDCP of the American Society of Transplantation has come out with a new guideline HERE on the epidemiology, diagnosis, prevention and management of methicillin-resistant Staphylococcus aureus (MRSA) infections in solid organ transplantation.
They also released a new guideline on the diagnosis, prevention, and management of infections due to multidrug-resistant (MDR) Gram-negative bacilli in the pre- and post-transplant period at HERE.
... And another one too on intra-abdominal infections in solid organ transplant recipients at HERE, as well as diagnosis, prevention and management of varicella zoster virus (VZV) in the pre- and post-transplant period at HERE.
Do you use 1 gram or 2 gram per day of ceftriaxone to treat CAP? According to this new meta analysis HERE, 1 gram fairs as good as the higher dose.
What is the evidence to support the use of Co-trimoxazole, Clindamycin, Doxycycline, and Minocycline in the treatment of MRSA pneumonia? Apparently not much. Head to this review HERE to read further.
Can we switch to oral Co-trimoxazole and Clindamycin in MRSA IE? Can we use this combo too at high dose up front for this indication? The answer will surprise you (Click HERE).
Early June 2019
HERE is an interesting review on the inoculum effect of β-lactam antibiotics. In fact, not all β-lactam antibiotics are equally affected by this phenomenon.
Are we now expert in dosing vancomycin or still learning how? This new study, PROVIDE, evaluates the association between clinical outcomes and vancomycin exposure in adult patients with MRSA bacteremia. A good editorial can also be read HERE.
A multicenter retrospective cohort study comparing between anti-MSSA in treating MSSA bacteremia – Click HERE to find out which anti-MSSA may not be as effective as the rest.
How often do you see PENICILLIN susceptible Staphylococcus aureus bacteremia in your institution and what would you use to treat the infection? Read THIS paper to find out if benzylpenicillin has the same outcome as flucloxacillin.
End of May 2019
Infectious Diseases (IDCOP) - American Society of Transplantation has recently released a new guideline on surgical site infections HERE.
What would be your to-go-to practices in antimicrobial stewardship? According to a panel of experts HERE, there are 2 interventions that they regards as the leading practices in ASP.
CRP can help reduce the use of antibiotics in COPD patients with acute exacerbation based on a new study performed in Netherlands. To know more, please click HERE.
Do you do 4 or 6 weeks of antibiotic therapy after implant removal in osteoarticular infection? According to a new trial, the shorter one yielded the same remission rates. Click HERE to read the paper.
Mid May 2019
Alternative non-IV carbapenem-sparing antibiotics could have a role in treating bloodstream infections due to Enterobacteriaceae-producing ESBL or AmpC β-lactamase? Read HERE for more details.
Current WHO guidelines do not recommend routine antibiotic prophylaxis for women undergoing operative vaginal delivery. Let's find out more about prophylactic antibiotics from this new multicentre RCT (ANODE) HERE.
Interested to learn about Eravacycline, the novel fluorocycline antibiotic from the tetracycline family? Follow the link HERE.
Antibiotics in the Pipeline for Treatment of Infections due to Gram-Negative Organisms: A systematic review. To read further please click HERE.
Ever wonder how clinicians think about the duration of therapy recommended for bacteremic illness? Click HERE to find out more.
Interesting articles on MAD-ID 2019.
Pip tazo and vancomycin combination can be toxic to kidneys based on a few reports. But THIS largest study to date suggests otherwise.
Can “NINJAs” reduce the risk of AKI in kids exposed to nephrotoxins like aminoglycosides? Yes, they can. To know more please click HERE.
Teaching stewardship to pharmacists in South Africa. HERE’s how Prof. Debra A. Goff did it.
What is the odd for inappropriate empiric therapy to be given in patients with GNB skin and soft tissue infections vs. GPC SSTI? It is 6 times higher. Read the report HERE to know more.
Early May 2019
Ceftazidime-avibactam vs meropenem for HAP/VAP; the result is in now HERE.
Complicated OPAT in the treatment of bone and joint infections- OVIVA study. Are you ready for it?; read it HERE.
Should we give a higher dose of influenza vaccine or perhaps an enhanced form of influenza vaccine in older patients? Click HERE for the answer. BTW, this site (https://www.accessss.org/) provides one with the most up-to-date "fast review" on recent paper/meta analysis with inputs from ID and other related experts on the papers.
ED pharmacists and their ability at slashing down the inappropriate antibiotic use. Click HERE for the news.
Where do the new antibiotics fit? Answer is HERE.
Mid April 2019
Increasing in Multidrug-resistant Gram-negative bacteria infections has resulted in the resurgence of old polymyxin antibiotics. However, with the introduction of other safer agents, how will these polymyxins be utilized? Click HERE to read on this interesting review on the future of Polymyxin Antibiotics.
Double β-Lactam Combination Therapy vs β-Lactam plus Aminoglycoside in Gram-negatives: Are they the same? Read more HERE.
What is the effect of β-Lactam Allergy on Management of Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections. Click HERE to find out.
Early April 2019
ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients. Read more HERE.
Optimization of the treatment with beta-lactam antibiotics in critically ill patients—guidelines from the French Society of Pharmacology and Therapeutics. Click HERE to download the guideline.
Should we adjust caspofungin dose in critically-ill patient in the absence of cirrhosis? A new paper to be read HERE.
Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes: The primary objective of this large cohort study was to determine the risk for poor outcomes in relation to bacteremia duration. Click HERE to read more.
Is Vancomycin inferior to β-Lactam antibiotics for the Early Treatment of Enterococcal Bacteraemia? Click HERE to find out.
Should we abandon gentamicin in the treatment of Streptococcal IE like what we did in the recent past for Staph. aureus IE too? Perhaps it is time to consider its removal too as per the review HERE.
Prolonged fever, evanescent rash and joint pain makes one thinks of AOSD/ adult’s onset still’s disease. Click HERE to read this new and good review on AOSD, which can be mistaken for infective fever.
Mosquitoes do not dig on house music, specifically this one particular song by Skrillex titled "Scary Monsters and Nice Sprites! . They hated it so much that they had less sex whilst listening to it. Let's play this song at full blast now while reading the news HERE and the full paper HERE.
A class is in session for OPAT in Future Learn at HERE by British Society for Antimicrobial Chemotherapy. Join now!!
End of 3/2019
These are new or updated guidelines from The American Society of Transplantation Infectious Diseases Community of Practice. Click on the title to read more on: Diagnosis and Management of Diarrhea in Solid Organ Transplant Recipients OR Invasive Aspergillosis in Solid Organ Transplant Recipients OR Pneumonia in Solid Organ Transplantation.
A new IDSA guideline for the management of asymptomatic bacteriuria (2019) HERE.
A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2017. Click HERE to read all top 13 interventions from antimicrobial stewardship-related publications.
Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteremia: a systematic review and meta-analysis. Check out THIS paper also at our paper highlight section.
Ceftaroline vs Vancomycin for the Treatment of ABSSSI at Risk of MRSA. The primary outcome of interest was to evaluate differences in clinical response at day 2 or 3 of antibiotic therapy. Click HERE to read more.
Should we treat Pseudomonas bacteremia with one or more antibiotics in older patients? The answer may surprise you HERE.
Post MERINO: Any role of pip-tazo for ESBL infections? A personal view by Maroun M.Sfeir HERE.
Can we treat latent TB infection for a month? According to a study called BRIEF-TB, the answer is YES. Click HERE to read a blog on this study (it has a link to the NEJM study too). Should we bring in rifapentine then dear Malaysia's ID physicians?
MID of 3/2019
What should we do when a patient is on both voriconazole and steroids? Do we need to increase or reduce the patient’s voriconazole dose? Head to THIS article to find out about it.
We may need to be careful when using acyclovir in patients who are obese according to a study done in UMMC. Obesity in this cohort was defined as BMI ≥ 30 and AKI was defined as per RIFLE criteria. Click HERE to read further.
Daptomycin Plus Ceftaroline versus Vancomycin as MRSA bacteremia initial treatment. What is your thought for this combo? Click HERE to find out more of this recently published paper.
ZEUS trial - Can we use IV Fosfomycin to treat complicated urinary tract infection? The result is promising and it offers a new therapeutic option with different MOA. Read it HERE.
A new guideline was just released by American Society of transplantation on drug-drug interactions between anti-infective and immunosuppressants. Head to THIS to read further.
This updated guideline from the American Society of Transplantation Infectious Diseases Community of Practice provides evidence-based and expert recommendations for screening, diagnosis, prevention and treatment of CMV in solid organ transplant recipients. Click HERE to download the guideline.
An extensive review on antibiotic penetration into bone and joints is just in. In this review, pharmacokinetics of commonly used antibiotics in both the serum and bone/joint are summarised. Please click HERE to read the paper.
Understanding mechanism of resistance can be challenging. These are two review articles recently published. Click HERE to read on AmpC Beta-Lactamases and HERE to read on another review paper - Interplay between β-lactamases and new β-lactamases inhibitors.
A new guideline was released on how best we should manage UTI as well as asymptomatic bacteriuria (ASB) in solid transplant patients. One of the highlight is the guideline concurs that there is no benefit of treating ASB 2 months post kidney transplantation. Please click HERE to read the guideline.
A new paper was recently published on ciprofloxacin optimal dosing in critically ill patients based on modeling done in this group of patients. The PD target of AUC24/MIC > 125 was selected for, against a range of MICs. Interestingly, the breakpoint of 0.25 mg/L was found when the target attainment was fixed at more than 95%. This is in stark contrast with the clinical breakpoints that are currently used in major guidelines for ciprofloxacin against Pseudomonas aeruginosa. Please click HERE to learn about this modeling in detail.
End of 2/2019
New guideline on vancomycin TDM is available for public comments. In this new guideline, the writers suggested the use of area-under-the-curve (AUC) instead of trough using Bayesian forecasting for vancomycin TDM. Alternatively, first order PK equations can be used to calculate the AUC. Please click HERE for the guideline.
A new trial on once-daily plazomicin for UTI can be read HERE. In this study, the researchers proved that the agent is non-inferior to meropenem in complicated UTI as well as pyelonephritis caused by Enterobacteriacea.
In septic patients, which one of these (CRT vs. lactate level) is a better strategy in sepsis management? Head to this paper to find out further.
Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers. This RCT is published in NEJM at HERE.
Methicillin- resistant Staphylococcus aureus: an overview of basic and clinical research published in Nature Reviews | Microbiology. Link is HERE.
AUC-Based Monitoring of Vancomycin: Closing the Therapeutic Window. And this is FREE and the link to this review is HERE.
Challenges in the management of septic shock: a narrative review. This is published in Intensive Care Medicine journal and the link to the paper is HERE.
Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection? The answer is NOT that straightforward. To read further please click HERE.