We don’t cover IPC, sorry.

Ask Infection Control Matters, those guys will know!

I think we’re doing an episode on it?

Maybe. Callum and Alyssa tell me nothing!

They invade hair and nail and skin
The diagnostics not so tough
And if the patient’s has enough
You can try some terbinafin(e)

So come on down and sub to pod
Give ID:IOTS a try tonight
And get an education
On managing Dermatophytes

#idsky #microsky #fungal #mould

Ever the salesman

Bit of Vitamin C’ll sort it out *

*or Vitamin A if you use Azithro as your main macrolide

I think in theory: Mouths are wet, and I think mouth to mouth on a patient with legionella is ill advised, to say the least. Not heard of it transmitted this way but haven’t looked.

I guess I’d try to get more information, seeing as the patient’s not sick:
1. Nature of penicillin allergy
2. Details of the other persons illness and death.

Assuming none of that is forthcoming, I’d go empirical for severe LRTI, and do resp viral testing.

Ceftriaxone/macrolide?

Ooh, that’s an interesting point. I’ve tried to move away from Broad and Narrow, but it’s so baked into our lexicon it’s difficult to avoid it completely.

Do you use other terms instead?

@kasic.bsky.social posts are a great place to start; I pointed ppl towards them when I was working in England and got great feedback; their influence spreads far beyond Kentucky! (They K stands for Kentucky they’re from Kentucky)

I guess I’ll stop here. I just wanted to add my thoughts to @kasic.bsky.social’s original post, and not just shitpost around it.

BTW if anyone’s after more stewardship resources…

The ‘medium’ & ‘narrow’ columns I’ve got more of an issue with; I’d probably move Vanc & Clinda into ‘medium’; here I think I’m being partially influenced by the UK version of WHO’s AWaRe classification of ABx:

Why don’t you want to use Aztreonam unless you have to? Because we need to reserve it for Rx DTR Gm negs.

The other agents in ‘broad spectrum’ are all antipseudomonal/important for Gm negs, so their use should be restricted on those grounds.

(FQ also have a poor side effect profile if course)

The issue I think is that spectrum isn’t the only determinant for de-escalation, which isn’t explicitly stated in this table; it’s stewardly use of ABx.

If you look at the spectrum for these drugs, you’ll see it’s all over the place.
AGs are arguably wider spectrum than Aztreonam;
So too Cotrim & Ceftriaxone
Doxy, HUGE spectrum, is in the middle
And in terms of C.diff risk, the highest risk agent (Clinda) is in the ‘narrow’ column.

Oh I forgot about that, did you or @absteward.bsky.social post that previously, in another place?

V interesting. I’m putting that in my ID:IOTS Guide to Co-trimoxazole when I get round to writing it!