Haven't been to Delaware but I can attest to the heat/humidity of the DC/Maryland area 🥵. Definitely feels like a breeding ground for Pseudomonas if every there was one

I do personally use ceftriaxone for that reason, I do know some people hate 3rd gen cephs due to the CDI rates though so included Unasyn as an alternative. But agree ceftriaxone is the better empiric option

Anti-Pseudomonal coverage for DFI is way overdone anyway. Ceftriaxone or Unasyn is sufficient for the majority of patients imo, +/- vanc.

Two weeks late with this point, but was reading through 2011 IDSA MRSA guidelines which give the same level of recommendation (B-II) for both linezolid and vanc for the treatment of MRSA CNS infections

www.idsociety.org/practice-gui...

Vancomycin may be more studied but not sure about more reliable, especially in the CNS. LZD has great CNS penetration (>70-90%) whereas vanc's is somewhat limited by its large size. This is alleviated by inflammation in the acute phase but LZD still has better serum:csf concentrations overall

Nothing drives me crazy like amox/clav or amp/sulbactam for strep or enterococcus

Caveat: some meds are designed with certain pharmacokinetic goals in mind. Aminoglycosides, for example generally work better with higher peak concentrations, so splitting the dose up is counterproductive despite achieving a smoother concentration

No, this isn't doing anything for the patient. I'm also not sure what they mean by "chronic" MRSA. If they have an active infection with those resistances, you would still have linezolid and tetracycline among other less common options. Oral vanc is just wiping out their GI flora

Would love to see this be a regular thing, I wasn't active during what people have called the golden days of ID Twitter so would thrilled to have a regular journal club in #IDSky

Agree, gentamicin is almost certainly still fine for Pseudomonas limited to the lower urinary tract. Systemic infections maybe not as much. Several other examples of situations where urinary concentrations overcome resistances, my favorite being using amox/amp for amp-resistant Enterococcus cystitis

I do as well, assuming no uncontrolled source of infection (ie retained stone). Haven't noticed any issues. I try to use TMP/SMX or FQ if able but our E. coli is only ~70% susceptible to those, so using a lot of Amox/clav, less frequently cephalexin or cefpodoxime, and sometimes even just plain amox

Wouldn't be my first choice certainly but I don't have a reason not to think it would work 🤷‍♂️

Is just delaying it enough? Would you like severe, potentially life threatening diarrhea in 2 weeks or 6? We really need better treatment and prevention for CDI #IDSky #Medsky

Bactrim will still be our first line for most things, but unfortunately our MRSA tetracycline susceptibilities are ~70% and dropping (clindas even worse). Will definitely have to keep in mind the toxicity aspect and awareness among our non-ID docs, thanks!

Oral penem's make me real nervous 😬 not just from a therapeutic standpoint, but from a resistance perspective, being available outpatient for anyone to prescribe. Really think we need to do a better job of leveraging PK/PD to use existing agents when possible #IDSky #AMSSky

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Would love to see what others use 👀 I have a personal one I use for unnecessary anaerobic coverage in aspiration pneumonia since it comes up frequently, although less and less

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