Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

🚫If you’re still recommending routine ECGs before starting ciprofloxacin in all patients — please stop. This is outdated practice.🚫 QT risk is low in patients without risk factors, and blanket screening adds no value. ECG should be reserved for high-risk patients after proper risk assessment.

@arthur_alb1 @BradSpellberg @DrToddLee A new study just published, is the effect seen unique to calrithro? Class effect? x.com/i/status/20401…

Thanks for sharing this RCT ( ACCESS RCT) 2 RCTs with contradicticting findings ACCESS RCT 224 positive outcomes for macro , calrithro CAP-STAR RCT no difference in mortality The population is the key , the macro type? ACCESS, mortality was very high and more severely I'll ( so it's probably in severe CAP) The REMAP CAP would prob the definitive answer to macrolide or not in CAP Check out this analysis by @MarcBonten letstalkscience.eu/2024/01/19/mac…

Time to revisit empiric atypical coverage in non-severe CAP? 🆕⚡🔴Target trial emulation using a propensity-weighted cohort from 68 hospitals in Michigan >66,000 patients: • No difference in time to clinical stability • No difference in ICU transfer or antibiotic duration • No difference in 30-day mortality • But ↓ composite 30-day mortality/rehospitalization with azithromycin Signal… or bias?” academic.oup.com/cid/article-ab…

@zacroBID Probably we can fix it @DrEmilyMcD x.com/i/status/18954…

@ABsteward People just can't quit using "step down" lol

🆕⚡🟢 Narrative Review Oral fosfomycin tromethamine for UTI: Guidance for clinicians #IDXposts sciencedirect.com/science/articl…

🆕⚡🟢Molecular pathways driving clarithromycin benefit in community-acquired pneumonia: analysis of the ACCESS i) Attenuation of the interleukin-1 cascade, ii) Increased production of monocyte-derived pro-inflammatory cytokines and chemokines coupled with improvement of antigen presentation, and iii) Reduction of neutrophil degranulation. thelancet.com/journals/ebiom…

@BradSpellberg @mcuban @mcuban I think you should take Dr. Spellberg up on his offer!

Excellent editorial @PriyaNori Much Ado About Macrolides: Revisiting Empiric Atypical Coverage in Non-severe Community-acquired Pneumonia academic.oup.com/cid/article-ab…

@ABsteward pubmed.ncbi.nlm.nih.gov/34697899/

@ABsteward Some evidence that we shouldn’t worry about this issue.

Who has made moves to remove routine atypical coverage for your non-severe CAP patients? #IDXPosts

@sarubactam @ABsteward @DrToddLee Several important points. 1) You are right--sadly, most of our decisions here are irrelevant bc most CAP is now viral. Very different even from when I trained in the 90s and early 00s. Turns out, vaccines work. 2) This means we way over treat routinely with abx. 3)...

"There remains equipoise regarding the benefit of empiric azithromycin with beta-lactam therapy in patients hospitalized with "non-severe " CAP" by🤔

@mcuban @mcuban, Im the CMO of the largest public hospital in the US West of Texas. Serious offer. Why not come for a visit? We can have a serious discussion about how to fix healthcare. We can walk you through our budget and issues. Would love your input and insights.

🆕⚡🔴American Society of Breast Surgeons, Society of Breast Imaging, and College of American Pathology 2025 Guidelines for the Management of Infectious and Inflammatory Lesions of the Breast #IDXposts jamanetwork.com/journals/jamas…

Should colonoscopy be routinely performed in Klebsiella Pneumoniae Liver Abscesses patients? A new retrospective cohort study provides insights! Klebsiella pneumoniae liver abscess as the herald of underlying colorectal neoplasm #IDXposts academic.oup.com/ofid/article/d…

@nicole_hunfeld Thanks, can you please share a link

@ABsteward Fully agree! We studied and published this…no QTc risk!

🚫If you’re still recommending routine ECGs before starting ciprofloxacin in all patients — please stop. This is outdated practice.🚫 QT risk is low in patients without risk factors, and blanket screening adds no value. ECG should be reserved for high-risk patients after proper risk assessment.

You're right for low risk patients with no other medications that could interact with QT interval or CYP3A4 or electrolytes. But for high risk patients or polymedicated ones, I'd still recommend an EKG Check QTMeds.com, to analyze your prescription against QT prolongation !