ID:IOTS podcasting / idiots-pod.bsky.social

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A chat with the UK’s Prémièrë pathogen lab, now on the podcast feed!

Now this an episode, first of a triple About all the work of a lab called RIPL And we'd like to take minute now so sit right here And learn about all the horrible pathogens you now should fear New episode now live! #IDXposts podcasts.apple.com/gb/podcast/id-…

@DrToddLee @BradSpellberg @ABsteward I think the supposed benefit is on the other side: reducing ADRs with long term use, by way of reducing dosage. Big Italian centre swears by it; but they can do Linez levels on-site. If you can’t do that, I think it gets more tricky…

Seeing a lot of linezolid TDM being performed recently Something new (or old and I missed it) published which shows benefit? @BradSpellberg @ABsteward

@DiorIzzy @DrToddLee I’m following this thread in case @DrToddLee DAIRs to answer

@DrToddLee Just following up on the ? I had for you re: DATIPO. Most of the 6 wk failures were in the DAIR group. 1/3 were S aureus. Do you think that might have favoured the 12wk duration? Coz I’ve had good success w 6 wks for Streps. And I’ve alp done 12 wks for S aureus.

@jdelpoleo @ClinicaNavarra Link to paper? I can’t seem to find it

Antibiotics Cover story: CONAN RCT findings support individualized antibiotic lock solution replacement strategies, potentially reducing the need for daily interventions. @ClinicaNavarra

@BradSpellberg @ABsteward @DrEmilyMcD @DrToddLee @DiorIzzy Correcting @BradSpellberg should go on your CV…

@DrEmilyMcD @DrToddLee Reposting Shorter Is Better table with error caught by @DiorIzzy corrected in the Exceptions table.

Two big changes to the Oral Is the New IV and Shorter Is Better Master Tables! First, shout out to @JRosenbergMDPhD for finding an oldie but goodie RCT of oral vs. IV artesunate for malaria--oral wins again! Oral Is the New IV Master Table updated, and reference on the website.

@DiorIzzy @BradSpellberg @KASIC_MDRO Oi, I said it too!

@BradSpellberg @KASIC_MDRO Source known, clearance of bacteremia, no metastatic infection = switch to TMP/SMX or linezolid as Dr S says & take out all IVs before they get infected. 👍

A pt is on D4 of vancomycin for MRSA bacteremia 2nd to a drained skin abscess. Pt is afebrile and wbc wnl. Repeat blood cultures are no growth to date. The MRSA vancomycin MIC is 2 mg/L. Change vanco to dapto?

@KASIC_MDRO No this guy’s going right on to Cotrim/Linez/Clinda* if I get my mitts on him! Say it’s a complicated BSI all you like, I reckon that affects duration, not agent choice. If we’re using orals for endocarditis I’m using it for MRSA BSI. *delete as appropriate

New episode! Alyssa and Jame are joined by Tihana Bicanic, to discuss the second great antifungal drug class, Echinocandins.  Part 1 of 2! (this episode we discuss the old stuff, next episode we discuss Rezafungin) #IDXposts #micro #fungi podcasts.apple.com/gb/podcast/id-…

@BradSpellberg @DiorIzzy @PulmCrit @vitorborin_ I think the main take home of this thread is that some arguments are better had in the pub over a pint.

@PulmCrit @vitorborin_ yes but the test you want to use has bad sensitivity/specificity. And your comparison to fever and WBC is not compelling. CRP is not substantively better, and more importantly, you are going to get the temperature and CBC already. CRP is not additive.

I'm sorry but CRP can be useful when admitting undifferentiated ICU patients (where history & exam are often minimal, eg 2/2 delirium) If you're getting involved >24 hours after admission it's easy to look down at the docs who were frantically sorting out an undifferentiated pt

Tell us more about this @BradSpellberg ; rifampicin for pseudomonas; activity, mechanism, dosing etc. is there a paper to go read, case series of use for PsA, etc? #idxposts

Consider this our post advertising the latest episode, ‘Biocide Bashing’, available now! Hold on to your Phallusocks ®️, this topic’s as scary as it gets! (That’ll make more sense after you listen) #IDxPosts #biocides #micro

@bbiebelberg @PulmCrit @ABsteward @BradSpellberg @ApuAkkad1 @dralicehan @IdVilchez @DrToddLee @jlsalinas7 @PrathitKulkarni @sargsyanz @NicholasRebold @cliffreid @BillFoxMD @MarvinBittner @moore_wjustin @matthewmof31 @laxswamy Oi In future tag me too for stuff like this This is brilliant data, thanks for doing it @bbiebelberg ! Question: did you compare 0 ABx vs any ABx?

Tagging folks who might be interested in this thread @PulmCrit @ABsteward @BradSpellberg @ApuAkkad1 @dralicehan @IdVilchez @DrToddLee @jlsalinas7 @PrathitKulkarni @sargsyanz @NicholasRebold @cliffreid @BillFoxMD @MarvinBittner @moore_wjustin @matthewmof31 @laxswamy

🦠Do all patients with viral pneumonia need antibiotics? 🫁This led to a fall-out between ATS and IDSA in the latest CAP guidelines In a new paper in @CIDJournal, we analyzed abx prescribing & outcomes among pts with viral CAP, and found no benefit from conventional abx 🧵⬇️

Some anti fungal episode with Alyssa & Jame is now LIVE! #IDXposts podcasts.apple.com/gb/podcast/id-…

@ABsteward If you told me this study was sponsored by the word ‘like’, I’d believe you completely.

“I'm like much more prone to doing vanc/zosyn than vanc/cefepime,just because that's just what we do here”[R3] “Yeah, there's very strict limitations on like using big gun antimicrobials like vanc & like mero”[R2] “Duration of antibiotics especially are like so vibes-base are we gonna treat this for like 5 days or like this is kinda severe so maybe we’ll do 10 or maybe even 14” [R3] @BradSpellberg 🆕⚡Feeling the Vibes:An Investigation into Resident Antibiotic Prescribing Practices academic.oup.com/ofid/article/d…

@BradSpellberg @DrToddLee @ABsteward I’ll take that action: I’ll bet that the antitoxic effect is a real world phenomenon, & if you were able to measure it somehow then it’d reduce with Clinda vs nothing… but there’s no difference with mortality, ITU admission/LOS, etc It’s gent for MSSA IE all over again…

@DrToddLee @ABsteward I will not take that bet unless you lay heavy odds! 😉

Clindamycin has historically been favoured for its toxin-inhibiting properties but increasing resistance and adverse effects have prompted interest in alternatives. This study evaluates the efficacy and safety of linezolid versus clindamycin plus anti-gram-positive therapy in patients with severe or necrotizing skin and soft tissue infections (SSTIs).

And here it is, Listeners Dearest The ID:IOTS Antibiotics Tier List Want to argue? Curse our names to God? Go right ahead; but sub to Pod And tell your friends about us, although It's likely it'll annoy them also podcasts.apple.com/gb/podcast/id-… #idXposts #microXposts #ID #infection

Yo ho ho, 4 our listeners dearest We present an ABx tier list Ranking drugs from S to D In a manner so Christmassy So sit back relax & have a drink As we discourse in cladist think And if u rank a different way We forgive u this Christmas Day #idXposts podcasts.apple.com/gb/podcast/id-…

@DrNeilStone I believe the six fingers are a ‘side efect’ of the vaccine…

This is highly accurate Friends call me "six fingers Stone"

@ABsteward @syctong @DrToddLee I don’t think so. Doesn’t non- 1G-Cephs have inferior outcomes in S.aureus infections? Also is only about 40% bioavailable compared to cefalexin’s 90%. Interesting to see what Pro-SNAP ends up showing…

@syctong @DrToddLee We don't have it here too! Would be interesting to know! What about cefuroxime? Is it good in MSSA BSI or SSTI ?

🆕⚡🚫💊 Not All OAT Inhibitors Are Equal — Ibuprofen Fails to Boost Flucloxacillin, IJAA, 2025 🚀 What they did 🧪 Single-site PK study in 10 healthy adults 💉 IV flucloxacillin 2 g BID × 3 days 💊 Ibuprofen 400 mg BID on days 2–3 🩸 ~52 PK samples per participant 🧬 📊 2-compartment PK models with saturable protein binding 🔍 Tested ibuprofen as covariate on clearance and protein binding 🔥 Key findings ❌ Ibuprofen had no effect on flucloxacillin PK (clearance, protein binding, unbound exposure) 🧱 Saturable protein binding model fit best (matches prior work) 📉 Despite theoretical OAT1/3 inhibition → no measurable effect 🧑‍⚕️ Infusion-site pain common; other AEs mild ⚠️ Limitations 👥 Small sample (10 healthy adults) 💊 Low-dose ibuprofen; higher doses or other NSAIDs may differ 🚫 No patients with renal impairment 🧪 Ibuprofen plasma concentrations not measured 💡 Takeaway 👉 Ibuprofen does not boost flucloxacillin exposure 👉 No role as a clearance inhibitor or “probenecid substitute” 👉 Not all OAT inhibitors behave the same — effects depend on drug, dose, and patient context 👉 Could higher NSAIDs doses, other NSAIDs, or different patient populations reveal an interaction? #IDXposts @jasonroberts_pk #bib0005" target="_blank" rel="nofollow noopener">sciencedirect.com:5037/science/articl…