Interesting! SubQ meropenem.
“Subcutaneous meropenem appears to be well tolerated and has a favourable pharmacokinetic profile. Either 1.5 g twice daily or 3 g as a 24 h subcutaneous infusion could be considered for future evaluation.”
academic.oup.com/jac/advance-...
“Subcutaneous meropenem appears to be well tolerated and has a favourable pharmacokinetic profile. Either 1.5 g twice daily or 3 g as a 24 h subcutaneous infusion could be considered for future evaluation.”
academic.oup.com/jac/advance-...
Safety, tolerability and pharmacokinetics of subcutaneous meropenem as an alternative to intravenous administration
AbstractBackground. Subcutaneous delivery of antibiotics is a practical alternative to IV administration. Meropenem is commonly used to treat infections ca
academic.oup.com
November 12, 2024 at 10:27 PM
#OTILT Doxycycline is added in Vibrio vulnifucus infections, as protein synthesis inhibition can counter MARTX toxin production. In a case report, a patient was initially treated for GAS SSTI. Doxycycline was added 4-5h later, following brackish water exposure reports, but within 48h, he died.
September 24, 2026 at 7:09 PM
#OTILT Doxycycline is added in Vibrio vulnifucus infections, as protein synthesis inhibition can counter MARTX toxin production. In a case report, a patient was initially treated for GAS SSTI. Doxycycline was added 4-5h later, following brackish water exposure reports, but within 48h, he died.
#OTILT When de-escalating to an oral antibiotic for definitive treatment of gram-negative BSIs, agents with high bioavailability, such as ciprofloxacin, may be preferred.
This study found higher risk of treatment failure when less bioavailable agents, such as beta-lactams, were used.
This study found higher risk of treatment failure when less bioavailable agents, such as beta-lactams, were used.
September 23, 2026 at 9:26 PM
#OTILT When de-escalating to an oral antibiotic for definitive treatment of gram-negative BSIs, agents with high bioavailability, such as ciprofloxacin, may be preferred.
This study found higher risk of treatment failure when less bioavailable agents, such as beta-lactams, were used.
This study found higher risk of treatment failure when less bioavailable agents, such as beta-lactams, were used.
Wooo last OTILT, congrats!
June 26, 2025 at 8:20 PM
Wooo last OTILT, congrats!
#OTILT Aztreonam is stable against metallo-beta-lactamase (MBL) hydrolysis, due to its monocyclic structure preventing MBL binding to the active site. However, ESBL and AmpC B-lactamases production limit monotherapy. Avibactam helps protect aztreonam because it inhibits these serine B-lactamases.
September 22, 2026 at 9:38 PM
#OTILT Aztreonam is stable against metallo-beta-lactamase (MBL) hydrolysis, due to its monocyclic structure preventing MBL binding to the active site. However, ESBL and AmpC B-lactamases production limit monotherapy. Avibactam helps protect aztreonam because it inhibits these serine B-lactamases.
#OTILT Although the SABATO trial demonstrated non-inferiority in oral step-down after 5-7 days of IV therapy for low-risk, uncomplicated S. aureus bacteremia, only ~4% of 5,063 screened patients were enrolled. In practice, knowing who qualifies for this switch matters as much as this trial's result
September 23, 2026 at 7:02 PM
#OTILT Although the SABATO trial demonstrated non-inferiority in oral step-down after 5-7 days of IV therapy for low-risk, uncomplicated S. aureus bacteremia, only ~4% of 5,063 screened patients were enrolled. In practice, knowing who qualifies for this switch matters as much as this trial's result
#OTILT A recent IDSA consensus statement suggests that a 2 week course of antibiotics for management of S.Aureus bacteremia may be sufficient for more patients than previously understood.
Specifically, an increased risk doesn’t automatically warrant a 4+ week antibiotic course.
Specifically, an increased risk doesn’t automatically warrant a 4+ week antibiotic course.
September 21, 2026 at 8:25 PM
#OTILT A recent IDSA consensus statement suggests that a 2 week course of antibiotics for management of S.Aureus bacteremia may be sufficient for more patients than previously understood.
Specifically, an increased risk doesn’t automatically warrant a 4+ week antibiotic course.
Specifically, an increased risk doesn’t automatically warrant a 4+ week antibiotic course.
#OTILT Clindamycin’s use in necrotizing fasciitis stems from it’s mechanism of action as a protein synthesis inhibitor. Necrotizing fasciitis releases toxins (proteins) that are blocked by clindamycin’s inhibition of protein synthesis.
September 16, 2026 at 12:52 AM
#OTILT Clindamycin’s use in necrotizing fasciitis stems from it’s mechanism of action as a protein synthesis inhibitor. Necrotizing fasciitis releases toxins (proteins) that are blocked by clindamycin’s inhibition of protein synthesis.
#OTILT One of Linezolid’s adverse effects is thrombocytopenia, typically defined as a platelet count less than 150,000/microliter. This can develop rapidly with patients’ platelet counts dropping significantly below baseline within a few days, often warranting Linezolid discontinuation.
September 26, 2026 at 2:50 AM
#OTILT One of Linezolid’s adverse effects is thrombocytopenia, typically defined as a platelet count less than 150,000/microliter. This can develop rapidly with patients’ platelet counts dropping significantly below baseline within a few days, often warranting Linezolid discontinuation.
#OTILT Although cefazolin is a common first-line agent used for MSSA infections, its efficacy can be compromised by the inoculum effect in high bacterial loads (ex: endocardial vegetations). Here, B-lactamase production can increase the MIC from a susceptible range to >/=16mcg/mL.
September 21, 2026 at 8:28 PM
#OTILT Although cefazolin is a common first-line agent used for MSSA infections, its efficacy can be compromised by the inoculum effect in high bacterial loads (ex: endocardial vegetations). Here, B-lactamase production can increase the MIC from a susceptible range to >/=16mcg/mL.
#OTILT Uncontrolled diabetes puts patients at high risk for infections caused by resistant organisms like Pseudomonas aeruginosa, as hyperglycemia interferes with polymorphonuclear leukocytes (PMNs). High blood sugar can reduce PMNs' migration, phagocytosis, and intracellular killing abilities.
September 15, 2026 at 9:00 PM
#OTILT Uncontrolled diabetes puts patients at high risk for infections caused by resistant organisms like Pseudomonas aeruginosa, as hyperglycemia interferes with polymorphonuclear leukocytes (PMNs). High blood sugar can reduce PMNs' migration, phagocytosis, and intracellular killing abilities.
#OTILT Rifampin is used as adjunct therapy in prosthetic joint infections as it effectively penetrates staphylococcal biofilms. However, it is not used alone- monotherapy or prolonged use can select for S. aureus resistance via point mutations in rpoB, a gene that encodes RNA polymerase's B-subunit
September 25, 2026 at 8:45 PM
#OTILT Rifampin is used as adjunct therapy in prosthetic joint infections as it effectively penetrates staphylococcal biofilms. However, it is not used alone- monotherapy or prolonged use can select for S. aureus resistance via point mutations in rpoB, a gene that encodes RNA polymerase's B-subunit
#OTILT is that radiotherapy increases a risk for cellulitis especially in breast cancer patients. @nicolegendy.bsky.social @jeffpears0n.bsky.social @bwdionne.bsky.social
www.redjournal.org/article/0360...
www.redjournal.org/article/0360...
www.redjournal.org
May 22, 2026 at 5:44 PM
#OTILT is that radiotherapy increases a risk for cellulitis especially in breast cancer patients. @nicolegendy.bsky.social @jeffpears0n.bsky.social @bwdionne.bsky.social
www.redjournal.org/article/0360...
www.redjournal.org/article/0360...
#OTILT Aside from its role in parkinsons disease, Amantadine used to be used in treatment of influenza A. While it continues to be used for PD, high levels of resistance led to it’s discontinued use in flu.
ajph.aphapublications.org/doi/full/10....
ajph.aphapublications.org/doi/full/10....
Changes in Prescribing of Antiviral Medications for Influenza Associated With New Treatment Guidelines | AJPH | Vol. 99 Issue S2
In 2006, the Centers for Disease Control and Prevention recommended discontinuing the use of adamantanes (amantadine and rimantadine) to treat influenza because of high levels of resistance to this cl...
ajph.aphapublications.org
September 24, 2026 at 4:38 PM
#OTILT Aside from its role in parkinsons disease, Amantadine used to be used in treatment of influenza A. While it continues to be used for PD, high levels of resistance led to it’s discontinued use in flu.
ajph.aphapublications.org/doi/full/10....
ajph.aphapublications.org/doi/full/10....
#OTILT is that corticosteroids blunt CRP responses, so a low CRP cannot reliably exclude infection.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
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pmc.ncbi.nlm.nih.gov
May 14, 2026 at 7:29 PM
#OTILT is that corticosteroids blunt CRP responses, so a low CRP cannot reliably exclude infection.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
#OTILT is that inhaled amphotericin B lipid complex is used as antifungal prophylaxis in lung transplant patients.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
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pmc.ncbi.nlm.nih.gov
June 9, 2026 at 12:45 AM
#OTILT is that inhaled amphotericin B lipid complex is used as antifungal prophylaxis in lung transplant patients.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
#OTILT Distributive shock (sepsis neurogenic) involves low afterload due to systemic vasodilation. Hypovolemic shock results from decreased preload and is managed with fluid resuscitation. Cardiogenic shock occurs when cardiac output is reduced and is treated with inotropes/revascularization.
October 7, 2025 at 5:14 PM
#OTILT Distributive shock (sepsis neurogenic) involves low afterload due to systemic vasodilation. Hypovolemic shock results from decreased preload and is managed with fluid resuscitation. Cardiogenic shock occurs when cardiac output is reduced and is treated with inotropes/revascularization.
#OTILT is that combining sofosbuvir with amiodarone can cause bradycardia, and this interaction should be avoided.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
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pmc.ncbi.nlm.nih.gov
May 20, 2026 at 7:22 PM
#OTILT is that combining sofosbuvir with amiodarone can cause bradycardia, and this interaction should be avoided.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@saanyav.bsky.social
pmc.ncbi.nlm.nih.gov/articles/PMC...
#OTILT In patients with recurrent C.Diff infection, treatment using a Vancomycin taper showed more sustained symptom resolution compared to a standard vancomycin course.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@amychun.bsky.social
academic.oup.com/ofid/article...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@amychun.bsky.social
academic.oup.com/ofid/article...
548. A Randomized, Double-blind, Controlled Trial of Vancomycin Taper/Pulse and Fidaxomicin compared to Vancomycin for Treatment of a First or Second Recurrence of Clostridioides difficile Infection
AbstractBackground. Vancomycin taper followed by pulse and fidaxomicin are two common treatments for recurrent C. difficile infection (rCDI) but they have
academic.oup.com
September 22, 2026 at 4:24 PM
#OTILT In patients with recurrent C.Diff infection, treatment using a Vancomycin taper showed more sustained symptom resolution compared to a standard vancomycin course.
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@amychun.bsky.social
academic.oup.com/ofid/article...
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@amychun.bsky.social
academic.oup.com/ofid/article...
#OTILT Flucytosine is never used as monotherapy, due to high risk of resistance that can arise from altering any step of its activation, whether by genetic mutations of cytosine permease, cytosine deaminase, or an increase in pyrimidine production, a competitive substrate.
September 18, 2026 at 9:19 PM
#OTILT Flucytosine is never used as monotherapy, due to high risk of resistance that can arise from altering any step of its activation, whether by genetic mutations of cytosine permease, cytosine deaminase, or an increase in pyrimidine production, a competitive substrate.
#OTILT Elizabethkingia, a gram-negative bacteria with high intrinsic resistance, is susceptible to vancomycin—one of the only gram-negatives where vanc works!
@jeffpears0n.bsky.social
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@bwdionne.bsky.social
June 4, 2025 at 12:11 AM
#OTILT Elizabethkingia, a gram-negative bacteria with high intrinsic resistance, is susceptible to vancomycin—one of the only gram-negatives where vanc works!
@jeffpears0n.bsky.social
@bwdionne.bsky.social
@jeffpears0n.bsky.social
@bwdionne.bsky.social
#OTILT is administering ceftaz/avi shortly before aztreonam provides maximum synergistic effect against gram negative bacteria when these agents are used together. @bwdionne.bsky.social @nicolegendy.bsky.social @jeffpears0n.bsky.social
journals.lww.com/cmre/fulltex...
journals.lww.com/cmre/fulltex...
journals.lww.com
June 1, 2026 at 5:38 PM
#OTILT is administering ceftaz/avi shortly before aztreonam provides maximum synergistic effect against gram negative bacteria when these agents are used together. @bwdionne.bsky.social @nicolegendy.bsky.social @jeffpears0n.bsky.social
journals.lww.com/cmre/fulltex...
journals.lww.com/cmre/fulltex...
#OTILT Hepatitis D infection requires previous or co-infection with HepB to replicate and coinfection may result in more rapid liver cirrhossis and disease progression. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
May 23, 2025 at 8:04 PM
#OTILT Hepatitis D infection requires previous or co-infection with HepB to replicate and coinfection may result in more rapid liver cirrhossis and disease progression. @bwdionne.bsky.social @jeffpears0n.bsky.social @juliaiburke.bsky.social
#OTILT Ivermectin is commonly used for the treatment of Strongyloides stercoralis infection. In a multi center phase 3 study, multiple doses of ivermectin was not shown to be more efficacious than a single dose of ivermectin for the treatment of strongyloidiasis.
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
August 20, 2025 at 7:23 PM
#OTILT Ivermectin is commonly used for the treatment of Strongyloides stercoralis infection. In a multi center phase 3 study, multiple doses of ivermectin was not shown to be more efficacious than a single dose of ivermectin for the treatment of strongyloidiasis.
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
#OTILT
The recommended minimum therapy for Candidemia without metastatic complications is 2 weeks after documented clearance of candida from the bloodstream after symptoms related to Candidemia has resolved.
www.idsociety.org/practice-gui...
@cheungalison.bsky.social @bwdionne.bsky.social
The recommended minimum therapy for Candidemia without metastatic complications is 2 weeks after documented clearance of candida from the bloodstream after symptoms related to Candidemia has resolved.
www.idsociety.org/practice-gui...
@cheungalison.bsky.social @bwdionne.bsky.social
Candidiasis
Invasive infection due to Candida species is largely a condition associated with medical progress, and is widely recognized as a major cause of morbidity and mortality in the healthcare environment. T...
www.idsociety.org
July 29, 2025 at 10:58 PM
#OTILT
The recommended minimum therapy for Candidemia without metastatic complications is 2 weeks after documented clearance of candida from the bloodstream after symptoms related to Candidemia has resolved.
www.idsociety.org/practice-gui...
@cheungalison.bsky.social @bwdionne.bsky.social
The recommended minimum therapy for Candidemia without metastatic complications is 2 weeks after documented clearance of candida from the bloodstream after symptoms related to Candidemia has resolved.
www.idsociety.org/practice-gui...
@cheungalison.bsky.social @bwdionne.bsky.social