One of the biggest reasons why we need antibiotic stewardship is to avoid creating scary monsters like this⬇️. How are you going to treat this?

A clinical practice guideline for tuberculous meningitis @TheLancetInfDis . ➡️Diagnostic approach.➡️Treatment and follow-up.

Join millions who have switched to Grok.

This retrospective cohort from 🇫🇷showed that oral switch is a suitable option for treating IE, even for POET-ineligible patients. ➡️treatment failure HR=0.55 favoring oral, 95%CI 0.27-1.17.➡️more days alive outside 🏥 in oral group (59 vs 47, p=0.001).

Amoxicillin crystalluria (AC) and amoxicillin-induced crystal nephropathy (AICN): a narrative review.➡️pathophysiology.➡️step-by-step diagnosis. HDIVA = high dose IV amoxicillin (≥150 mg/kg or ≥8 g per day).

So far 51 RCT covering 8 conditions show that oral antibiotics are equal to IV. Can anyone quote some RCT that shows IV is better than oral?😏. #oralisthenewIV.

Sulfonamide allergy usually involves sulfonamide antimicrobials (e.g. TMPSMX) due to their N1 and N4 side chains. Risk of cross-reactivity to non-antimicrobial sulfonamides or non-sulfonamide sulfur drugs is very low because of structural difference.

Timeline of chikungunya fever. Typical viral load, symptoms, involved immune cells, and antibody titres during different phases of disease are depicted.

Unlike most drugs, fluconazole dose needs to be INCREASED during CRRT. Why?. Under normal conditions, >80% of fluconazole is renally excreted as unchanged drug, followed by extensive tubular reabsorption. And this process is bypassed during CRRT

Narrative review on fungal diagnostics @CMIJournal.

RT @AliSMV7: Static vs. cidal: it’s not complex; it’s simply incorrect. @BradSpellberg @DrToddLee @ABsteward .

Summary:.1. Lung USG 🆗 for diagnosis.2.Empiric antibiotics suggested for CAP tested +ve for resp virus if in-pt or have comorbidities.3. <5 days antibiotics (min 3 days) if stable, except for in-pt with severe CAP.4. Systemic steroid suggested for in-pt with severe CAP.

In this study from 🇳🇱 involving 400+ patients who underwent hip or knee explanation, the use of sonication fluid culture (vs tissue culture alone) detected additional microorganisms that could impact antibiotic choice in 8% to 20% of PJI cases.

"If we prescribe antibiotics unnecessarily, we may be the reason that someone develops life altering conditions years later in life or why months down the line they do not experience the response to cancer immunotherapy they desperately hoped for.".

Do you know where the recommendation of adjunctive therapy for E.faecalis IE came from? . A case series published in 1954 (with numerous limitations). Time for a well-designed RCT of adjunctive versus monotherapy indeed.

If discussion on ceilings of care is applicable to resuscitation, ventilatory support, or even blood taking.Why shouldn't it be applied to antimicrobial use too?. Communication strategies and skills for antimicrobial treatment discussions at end of life⬇️.

Structured linezolid dose reduction (600mg/d➡️300mg/d after 9-13 weeks) had comparable recurrence free cure rates as fixed linezolid 600mg/d when given along with bedaquiline and pretomanid for 26 weeks in PreXDR TB.

RT @drtimothyli: Infections associated with marine exposure. 1/9

Should secondary SBP prophylaxis (SecSBPPr) still be given in cirrhosis?. In 2 🇺🇸national cohorts (>11000 SBP patients), SecSBPPr⬆️the risk of SBP recurrence in multivariable analysis by 63%–68% vs no prophylaxis. And this trend worsened over time.

Candida infective endocarditis 🍄🫀🤒. ➡️Suggested management algorithm based on valve type and surgical eligibility.➡️Follow-up recommendations.

Routine weekly surveillance for MDR-GNB in hematologic patients enables early identification of colonization, often preceding MDR-GNB BSIs. ➡️Rectal swabs positive in 27.5% of patients.➡️BSI occurred in 38.5% colonised vs 12.0% non-colonised patients.

Possible mechanisms for benefits of S. boulardii:.⭐competition with C. diff for essential nutrients and attachment sites in the GI tract.⭐produces antimicrobial substances e.g.acetic acid.⭐modulate the immune response by ⬆️production of immunoglobulins and other immune factors.