Jonathan Ryder, MD
@jonathanrydermd.bsky.social
Adult ID and Assistant Prof at UNMC | Former IUSM IM & Truman State | Abx Stewie, Infxn Prevention, Digital MedEd, Podcasts, Medical History, Reading Non-Fiction, Running/Cycling | Posts are mine
Guilty as charged
November 11, 2025 at 2:11 PM
Guilty as charged
The more I learn about sinks...the more grossed out that I get
November 6, 2025 at 6:35 PM
The more I learn about sinks...the more grossed out that I get
🤯 That's 6 Big Macs a day!
Is this co-formulated with furosemide?
Is this co-formulated with furosemide?
November 5, 2025 at 10:16 PM
🤯 That's 6 Big Macs a day!
Is this co-formulated with furosemide?
Is this co-formulated with furosemide?
Reposted by Jonathan Ryder, MD
Who knows, you guys might even get temocillin soon too! 😉
My take: IV fosfo has a couple of handy off-label uses... tricky VRE infections (in combo), occasional meningitis with unusual orgs/allergies, resistant pyelo when beta-lactams truly contraindicated.
Sodium load is a real issue tho.
My take: IV fosfo has a couple of handy off-label uses... tricky VRE infections (in combo), occasional meningitis with unusual orgs/allergies, resistant pyelo when beta-lactams truly contraindicated.
Sodium load is a real issue tho.
November 5, 2025 at 8:46 PM
Who knows, you guys might even get temocillin soon too! 😉
My take: IV fosfo has a couple of handy off-label uses... tricky VRE infections (in combo), occasional meningitis with unusual orgs/allergies, resistant pyelo when beta-lactams truly contraindicated.
Sodium load is a real issue tho.
My take: IV fosfo has a couple of handy off-label uses... tricky VRE infections (in combo), occasional meningitis with unusual orgs/allergies, resistant pyelo when beta-lactams truly contraindicated.
Sodium load is a real issue tho.
From some unpublished data we have with meningitis, among ~40 patients with meningitis/encephalitis panels receiving empiric meningitis antibiotics (vanc/CRO etc), only 1 culture had Strep pneumo. Still only ~2-2.5% incidence of Strep pneumo in that higher pre-test probability population
November 5, 2025 at 8:31 PM
From some unpublished data we have with meningitis, among ~40 patients with meningitis/encephalitis panels receiving empiric meningitis antibiotics (vanc/CRO etc), only 1 culture had Strep pneumo. Still only ~2-2.5% incidence of Strep pneumo in that higher pre-test probability population
I feel like I need an ID fellowship in Europe...IV fosfo, pivmecillinam...what's next?!
November 5, 2025 at 8:27 PM
I feel like I need an ID fellowship in Europe...IV fosfo, pivmecillinam...what's next?!
Tolerability is my big question....would be nice to have a beta-lactam-sparing MDR GNR agent....but not super interested in causing severe electrolyte abnormalities when our other agents are fairly safe
November 5, 2025 at 7:48 PM
Tolerability is my big question....would be nice to have a beta-lactam-sparing MDR GNR agent....but not super interested in causing severe electrolyte abnormalities when our other agents are fairly safe
In 2 years, we had 453 meningitis/encephalitis panels performed. Only 5 (1.1%) had Strep pneumo. Strep pneumo meningitis is a rare diagnosis. Would require a decade of data from multiple centers to even figure out how many are CRO-R!
www.sciencedirect.com/science/arti...
www.sciencedirect.com/science/arti...
Evaluation of cerebrospinal fluid white blood cell count criteria for use of the BioFire® FilmArray® Meningitis/Encephalitis Panel in immunocompromised and nonimmunocompromised patients
We implemented the BioFire® FilmArray® Meningitis/Encephalitis Panel (MEP) with guidance for use based on patient age, cerebrospinal fluid (CSF) white…
www.sciencedirect.com
November 5, 2025 at 7:46 PM
In 2 years, we had 453 meningitis/encephalitis panels performed. Only 5 (1.1%) had Strep pneumo. Strep pneumo meningitis is a rare diagnosis. Would require a decade of data from multiple centers to even figure out how many are CRO-R!
www.sciencedirect.com/science/arti...
www.sciencedirect.com/science/arti...
Reposted by Jonathan Ryder, MD
If 1% of ED LPs end up being for Pneumo, and 1% of Pneumo in adults is R, you will do 10,000 vanco courses for every 1 patient with CTX-R pneumococcal meningitis. That will definitely cause a large amount of AKIs and VREs.
In LA, we recommend NOT adding vanco until LP CSF WBC/% PMN known.
In LA, we recommend NOT adding vanco until LP CSF WBC/% PMN known.
November 5, 2025 at 3:52 PM
If 1% of ED LPs end up being for Pneumo, and 1% of Pneumo in adults is R, you will do 10,000 vanco courses for every 1 patient with CTX-R pneumococcal meningitis. That will definitely cause a large amount of AKIs and VREs.
In LA, we recommend NOT adding vanco until LP CSF WBC/% PMN known.
In LA, we recommend NOT adding vanco until LP CSF WBC/% PMN known.
Reposted by Jonathan Ryder, MD
Yup, posted on the other platform. For PK, 2 gm CTX Cmax blood 250 mcg/ml, 10% CSF = 25 at peak. 4-6 hr half life:
T0 = 25
T4 = 12.5
T8 = 6.25
T12 = 3.125 --should be above MIC whole interval.
As far as the massive overuse of vanco, does depend on geography. In much of US, CTX-R rare in adults...
T0 = 25
T4 = 12.5
T8 = 6.25
T12 = 3.125 --should be above MIC whole interval.
As far as the massive overuse of vanco, does depend on geography. In much of US, CTX-R rare in adults...
November 5, 2025 at 3:52 PM
Yup, posted on the other platform. For PK, 2 gm CTX Cmax blood 250 mcg/ml, 10% CSF = 25 at peak. 4-6 hr half life:
T0 = 25
T4 = 12.5
T8 = 6.25
T12 = 3.125 --should be above MIC whole interval.
As far as the massive overuse of vanco, does depend on geography. In much of US, CTX-R rare in adults...
T0 = 25
T4 = 12.5
T8 = 6.25
T12 = 3.125 --should be above MIC whole interval.
As far as the massive overuse of vanco, does depend on geography. In much of US, CTX-R rare in adults...