José Molina
@josemolinagb.bsky.social
ID doc & Antibiotic Steward •
• Clinical trials and #FOAMed believer •
Now on @shorten2trial.bsky.social
#AMSsky #IDSky #AMR
Hospital Virgen del Rocío • Seville, Spain 🇪🇸
• Clinical trials and #FOAMed believer •
Now on @shorten2trial.bsky.social
#AMSsky #IDSky #AMR
Hospital Virgen del Rocío • Seville, Spain 🇪🇸
Totally agree. Definitely not for any CAP.
I was also shocked by the mean age (>80y) and Charlson. Probably this was a major driver for the high mortality, beyond the severity of the infection itself — mean CURB65 was 2-3, the setting for recruitment were Internal Medicine wards instead of ICUs…
I was also shocked by the mean age (>80y) and Charlson. Probably this was a major driver for the high mortality, beyond the severity of the infection itself — mean CURB65 was 2-3, the setting for recruitment were Internal Medicine wards instead of ICUs…
October 18, 2025 at 5:18 PM
Totally agree. Definitely not for any CAP.
I was also shocked by the mean age (>80y) and Charlson. Probably this was a major driver for the high mortality, beyond the severity of the infection itself — mean CURB65 was 2-3, the setting for recruitment were Internal Medicine wards instead of ICUs…
I was also shocked by the mean age (>80y) and Charlson. Probably this was a major driver for the high mortality, beyond the severity of the infection itself — mean CURB65 was 2-3, the setting for recruitment were Internal Medicine wards instead of ICUs…
I have the same concern!
In this RCT, 25% of patients received steroids in both arms.
The subgroup analysis showed benefits independently (and apparently superior) to the use of steroids, but this relevant question was not primarily addressed by the trial
pdf.sciencedirectassets.com/271247/1-s2....
In this RCT, 25% of patients received steroids in both arms.
The subgroup analysis showed benefits independently (and apparently superior) to the use of steroids, but this relevant question was not primarily addressed by the trial
pdf.sciencedirectassets.com/271247/1-s2....
October 18, 2025 at 4:58 PM
I have the same concern!
In this RCT, 25% of patients received steroids in both arms.
The subgroup analysis showed benefits independently (and apparently superior) to the use of steroids, but this relevant question was not primarily addressed by the trial
pdf.sciencedirectassets.com/271247/1-s2....
In this RCT, 25% of patients received steroids in both arms.
The subgroup analysis showed benefits independently (and apparently superior) to the use of steroids, but this relevant question was not primarily addressed by the trial
pdf.sciencedirectassets.com/271247/1-s2....
I think REMAP-CAP has ongoing domains to adress this question, hopefully we’ll get new data soon to confirm the hypothesis
🤞🏻 www.remapcap.eu/domains/
🤞🏻 www.remapcap.eu/domains/
October 18, 2025 at 9:18 AM
I think REMAP-CAP has ongoing domains to adress this question, hopefully we’ll get new data soon to confirm the hypothesis
🤞🏻 www.remapcap.eu/domains/
🤞🏻 www.remapcap.eu/domains/
I’ve always been skeptical on the antinflammatory role of macrolides too, but ACCESS RCT made me reconsider.
Results seem consistent across all endpoints and subgroups, and biologically plausible 🤔
A post-hoc analysis suggested the effect is independent -maybe superior- to steroids #AMSsky #IDsky
Results seem consistent across all endpoints and subgroups, and biologically plausible 🤔
A post-hoc analysis suggested the effect is independent -maybe superior- to steroids #AMSsky #IDsky
October 18, 2025 at 9:10 AM
Agree!
Also, max dose isn’t always about GI tolerance: absorption matters too.
Hydrophilic drugs like BL need transporters in intestinal epithelium that saturate. So beyond a certain dose (e.g.1g amoxicillin), more drug ≠ more exposure!
A review on the topic 👉🏻 www.sciencedirect.com/science/arti...
Also, max dose isn’t always about GI tolerance: absorption matters too.
Hydrophilic drugs like BL need transporters in intestinal epithelium that saturate. So beyond a certain dose (e.g.1g amoxicillin), more drug ≠ more exposure!
A review on the topic 👉🏻 www.sciencedirect.com/science/arti...
July 21, 2025 at 8:57 AM
Agree!
Also, max dose isn’t always about GI tolerance: absorption matters too.
Hydrophilic drugs like BL need transporters in intestinal epithelium that saturate. So beyond a certain dose (e.g.1g amoxicillin), more drug ≠ more exposure!
A review on the topic 👉🏻 www.sciencedirect.com/science/arti...
Also, max dose isn’t always about GI tolerance: absorption matters too.
Hydrophilic drugs like BL need transporters in intestinal epithelium that saturate. So beyond a certain dose (e.g.1g amoxicillin), more drug ≠ more exposure!
A review on the topic 👉🏻 www.sciencedirect.com/science/arti...
You’re right, maybe the term isn’t ideal here.
I think they mean oral cipro can maintain exposure thanks to higher doses than IV.
But oral BLs usually mean lower total doses than their IV equivalents (cefazolin 2g/8h, amox/clav 1g/200mg/8h…).
I had a slide on this from a previous ESCMID Global! 😉
I think they mean oral cipro can maintain exposure thanks to higher doses than IV.
But oral BLs usually mean lower total doses than their IV equivalents (cefazolin 2g/8h, amox/clav 1g/200mg/8h…).
I had a slide on this from a previous ESCMID Global! 😉
July 20, 2025 at 11:42 PM
You’re right, maybe the term isn’t ideal here.
I think they mean oral cipro can maintain exposure thanks to higher doses than IV.
But oral BLs usually mean lower total doses than their IV equivalents (cefazolin 2g/8h, amox/clav 1g/200mg/8h…).
I had a slide on this from a previous ESCMID Global! 😉
I think they mean oral cipro can maintain exposure thanks to higher doses than IV.
But oral BLs usually mean lower total doses than their IV equivalents (cefazolin 2g/8h, amox/clav 1g/200mg/8h…).
I had a slide on this from a previous ESCMID Global! 😉
Hopefully, we will have data from a RCT to solve the question on the efficacy of oral BL for bacteremic infections and cUTI.
BALANCE has evolved to a platform trial (BALANCE+) which have included this in one of its domains! 🤞🏻🇨🇦 (🧵4/4)
www.ccctg.ca/trials-and-s... #IDsky #UTIsky #AMSsky
BALANCE has evolved to a platform trial (BALANCE+) which have included this in one of its domains! 🤞🏻🇨🇦 (🧵4/4)
www.ccctg.ca/trials-and-s... #IDsky #UTIsky #AMSsky
July 20, 2025 at 10:24 PM
Hopefully, we will have data from a RCT to solve the question on the efficacy of oral BL for bacteremic infections and cUTI.
BALANCE has evolved to a platform trial (BALANCE+) which have included this in one of its domains! 🤞🏻🇨🇦 (🧵4/4)
www.ccctg.ca/trials-and-s... #IDsky #UTIsky #AMSsky
BALANCE has evolved to a platform trial (BALANCE+) which have included this in one of its domains! 🤞🏻🇨🇦 (🧵4/4)
www.ccctg.ca/trials-and-s... #IDsky #UTIsky #AMSsky
Do AMS really work in transplant units and what is yet to be done?
Happy to share our systematic review in @eclinicalmed.bsky.social which we hope will support AB stewardship implementation in SOT units and future research steps #AMSsky #TxID #IDsky
kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...
Happy to share our systematic review in @eclinicalmed.bsky.social which we hope will support AB stewardship implementation in SOT units and future research steps #AMSsky #TxID #IDsky
kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...
July 4, 2025 at 3:41 AM
Do AMS really work in transplant units and what is yet to be done?
Happy to share our systematic review in @eclinicalmed.bsky.social which we hope will support AB stewardship implementation in SOT units and future research steps #AMSsky #TxID #IDsky
kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...
Happy to share our systematic review in @eclinicalmed.bsky.social which we hope will support AB stewardship implementation in SOT units and future research steps #AMSsky #TxID #IDsky
kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...
Hopefully, POET-II RCT will give us the answer. They are recruiting a wide range of endocarditis, including complicated cases like this!
They propose a 3-weeks duration for strep IE with abscesses 👇🏻
www.sciencedirect.com/science/arti... #IDSky #AMSsky
They propose a 3-weeks duration for strep IE with abscesses 👇🏻
www.sciencedirect.com/science/arti... #IDSky #AMSsky
May 24, 2025 at 8:48 AM
Hopefully, POET-II RCT will give us the answer. They are recruiting a wide range of endocarditis, including complicated cases like this!
They propose a 3-weeks duration for strep IE with abscesses 👇🏻
www.sciencedirect.com/science/arti... #IDSky #AMSsky
They propose a 3-weeks duration for strep IE with abscesses 👇🏻
www.sciencedirect.com/science/arti... #IDSky #AMSsky
Caring for patients with bronchiectasis poses a challenge for both pulmonologists and #AMSky teams.
Standard 14d treatments for exacerbations lack good evidence support.
This small RCT favors shorter durations such as 8d 👉🏻 publications.ersnet.org/content/erj/... #IDsky @bradspellberg.bsky.social
Standard 14d treatments for exacerbations lack good evidence support.
This small RCT favors shorter durations such as 8d 👉🏻 publications.ersnet.org/content/erj/... #IDsky @bradspellberg.bsky.social
May 4, 2025 at 12:43 AM
Caring for patients with bronchiectasis poses a challenge for both pulmonologists and #AMSky teams.
Standard 14d treatments for exacerbations lack good evidence support.
This small RCT favors shorter durations such as 8d 👉🏻 publications.ersnet.org/content/erj/... #IDsky @bradspellberg.bsky.social
Standard 14d treatments for exacerbations lack good evidence support.
This small RCT favors shorter durations such as 8d 👉🏻 publications.ersnet.org/content/erj/... #IDsky @bradspellberg.bsky.social
Could stewardship interventions targeting steroids and PPI prevent HAIs and reduce antibiotic use in hospitals?
This study shows a time- and dose-dependent association between PPI & steroids and the incidence of HAIs: www.journalofhospitalinfection.com/callback?red...
#AMSky #IDsky #IPSky #PharmSky
This study shows a time- and dose-dependent association between PPI & steroids and the incidence of HAIs: www.journalofhospitalinfection.com/callback?red...
#AMSky #IDsky #IPSky #PharmSky
May 1, 2025 at 2:53 PM
Could stewardship interventions targeting steroids and PPI prevent HAIs and reduce antibiotic use in hospitals?
This study shows a time- and dose-dependent association between PPI & steroids and the incidence of HAIs: www.journalofhospitalinfection.com/callback?red...
#AMSky #IDsky #IPSky #PharmSky
This study shows a time- and dose-dependent association between PPI & steroids and the incidence of HAIs: www.journalofhospitalinfection.com/callback?red...
#AMSky #IDsky #IPSky #PharmSky
2025 Update of SPIRIT guidelines for RCT protocols: www.thelancet.com/action/showP... #IDSky #Medsky
April 29, 2025 at 9:58 PM
2025 Update of SPIRIT guidelines for RCT protocols: www.thelancet.com/action/showP... #IDSky #Medsky
How to safely use LLM (like ChatGPT) in your daily work, by @joserrapa.bsky.social.
Fantastic talk on AI use for antibiotic stewardship in #ESCMIDGlobal!
#AMSky
Fantastic talk on AI use for antibiotic stewardship in #ESCMIDGlobal!
#AMSky
April 14, 2025 at 1:44 PM
How to safely use LLM (like ChatGPT) in your daily work, by @joserrapa.bsky.social.
Fantastic talk on AI use for antibiotic stewardship in #ESCMIDGlobal!
#AMSky
Fantastic talk on AI use for antibiotic stewardship in #ESCMIDGlobal!
#AMSky
Shorter is greener! 🍃♻️
Unnecessary antibiotics contribute to greenhouse gas emmissions. Want to know how much? 👉🏻 shorturl.at/52wOT
Fantastic point! #IDSky #AMSsky
Unnecessary antibiotics contribute to greenhouse gas emmissions. Want to know how much? 👉🏻 shorturl.at/52wOT
Fantastic point! #IDSky #AMSsky
February 12, 2025 at 11:43 PM
Shorter is greener! 🍃♻️
Unnecessary antibiotics contribute to greenhouse gas emmissions. Want to know how much? 👉🏻 shorturl.at/52wOT
Fantastic point! #IDSky #AMSsky
Unnecessary antibiotics contribute to greenhouse gas emmissions. Want to know how much? 👉🏻 shorturl.at/52wOT
Fantastic point! #IDSky #AMSsky
Post-discharge prescriptions should be a key focus for #AMSsky!
In her fantastic talk at #ESCMIDglobal, @valerievaughnmd.bsky.social showed how >90% of antibiotic duration excess occurs post-discharge!
The ROADhome framework can be helpful for this task 👉🏻 academic.oup.com/cid/article/... #IDSky
In her fantastic talk at #ESCMIDglobal, @valerievaughnmd.bsky.social showed how >90% of antibiotic duration excess occurs post-discharge!
The ROADhome framework can be helpful for this task 👉🏻 academic.oup.com/cid/article/... #IDSky
February 12, 2025 at 11:15 PM
Post-discharge prescriptions should be a key focus for #AMSsky!
In her fantastic talk at #ESCMIDglobal, @valerievaughnmd.bsky.social showed how >90% of antibiotic duration excess occurs post-discharge!
The ROADhome framework can be helpful for this task 👉🏻 academic.oup.com/cid/article/... #IDSky
In her fantastic talk at #ESCMIDglobal, @valerievaughnmd.bsky.social showed how >90% of antibiotic duration excess occurs post-discharge!
The ROADhome framework can be helpful for this task 👉🏻 academic.oup.com/cid/article/... #IDSky
Our scientific society SEIMC publishes in @thelancet.bsky.social the burden of bacterial resistance across 130 hospitals in Spain in 2018-2023.
How will we face this urgent threat without an Infectious Diseases specialty in Spain @sanidad.gob.es?
www.thelancet.com/journals/lan...
How will we face this urgent threat without an Infectious Diseases specialty in Spain @sanidad.gob.es?
www.thelancet.com/journals/lan...
January 30, 2025 at 8:03 AM
Our scientific society SEIMC publishes in @thelancet.bsky.social the burden of bacterial resistance across 130 hospitals in Spain in 2018-2023.
How will we face this urgent threat without an Infectious Diseases specialty in Spain @sanidad.gob.es?
www.thelancet.com/journals/lan...
How will we face this urgent threat without an Infectious Diseases specialty in Spain @sanidad.gob.es?
www.thelancet.com/journals/lan...
Say hi to the Antibiotics Whisperer of BlueSky! 🤣
Love this crazy tool, thanks @kenkoonwong.bsky.social!
What about the Spanish Stewards crew? @joserrapa.bsky.social @listeriacolectiva.bsky.social @lgalvez.bsky.social @elenasalamancar.bsky.social @micromunidad.bsky.social @quiquecarus.bsky.social
Love this crazy tool, thanks @kenkoonwong.bsky.social!
What about the Spanish Stewards crew? @joserrapa.bsky.social @listeriacolectiva.bsky.social @lgalvez.bsky.social @elenasalamancar.bsky.social @micromunidad.bsky.social @quiquecarus.bsky.social
December 2, 2024 at 6:36 PM
Say hi to the Antibiotics Whisperer of BlueSky! 🤣
Love this crazy tool, thanks @kenkoonwong.bsky.social!
What about the Spanish Stewards crew? @joserrapa.bsky.social @listeriacolectiva.bsky.social @lgalvez.bsky.social @elenasalamancar.bsky.social @micromunidad.bsky.social @quiquecarus.bsky.social
Love this crazy tool, thanks @kenkoonwong.bsky.social!
What about the Spanish Stewards crew? @joserrapa.bsky.social @listeriacolectiva.bsky.social @lgalvez.bsky.social @elenasalamancar.bsky.social @micromunidad.bsky.social @quiquecarus.bsky.social
#ShorterIsBetter in immunocompromised hosts?
Short treatments are feasible in early responders without source control issues.
A significant number of observational studies serve as proof-of-concept on the feasibility of short courses in selected patients (see ⚠️)
#AMSsky #IDOnc #TxID #IDsky
Short treatments are feasible in early responders without source control issues.
A significant number of observational studies serve as proof-of-concept on the feasibility of short courses in selected patients (see ⚠️)
#AMSsky #IDOnc #TxID #IDsky
November 19, 2024 at 7:05 PM
#ShorterIsBetter in immunocompromised hosts?
Short treatments are feasible in early responders without source control issues.
A significant number of observational studies serve as proof-of-concept on the feasibility of short courses in selected patients (see ⚠️)
#AMSsky #IDOnc #TxID #IDsky
Short treatments are feasible in early responders without source control issues.
A significant number of observational studies serve as proof-of-concept on the feasibility of short courses in selected patients (see ⚠️)
#AMSsky #IDOnc #TxID #IDsky
We lack oral options for most MDR-GNB among current or upcoming antibiotics, so ambulatory care for these patients will relay largely on #OPAT.
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
November 17, 2024 at 11:33 AM
We lack oral options for most MDR-GNB among current or upcoming antibiotics, so ambulatory care for these patients will relay largely on #OPAT.
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
