@yoon-jun.bsky.social
#OTILT Stenotrophomonas maltophilia is an aerobic, nonfermentative, gram-negative organism that is often susceptible to TMP-SMX. However, it is a common colonizer in a respiratory tract. Therefore, a positive respiratory tract isolate of S. maltophilia does not necessitate an antimicrobial treatment
November 26, 2025 at 12:46 AM
#OTILT Stenotrophomonas maltophilia is an aerobic, nonfermentative, gram-negative organism that is often susceptible to TMP-SMX. However, it is a common colonizer in a respiratory tract. Therefore, a positive respiratory tract isolate of S. maltophilia does not necessitate an antimicrobial treatment
#OTILT Although linezolid may be a good option when used as an acute therapy, the treatment duration usually last about 6 weeks for bone and joint infection. In one study, linezolid demonstrated increased risk of ADEs such as GI intolerance, malaise and cytopenia when used for more than 28 days.
November 24, 2025 at 10:04 PM
#OTILT Although linezolid may be a good option when used as an acute therapy, the treatment duration usually last about 6 weeks for bone and joint infection. In one study, linezolid demonstrated increased risk of ADEs such as GI intolerance, malaise and cytopenia when used for more than 28 days.
#OTILT When Clostridium difficile infection is suspected, PCR test is conducted. However, positive PCR test does not necessarily distinguish between active disease and asymptomatic carriage. Therefore, positive C diff PCR does not definitively indicate need for treatment
November 22, 2025 at 2:14 AM
#OTILT When Clostridium difficile infection is suspected, PCR test is conducted. However, positive PCR test does not necessarily distinguish between active disease and asymptomatic carriage. Therefore, positive C diff PCR does not definitively indicate need for treatment
#OTILT Dolutegravir, an INSTI for HIV, may increase the serum level of metformin when used concomitantly. One possible mechanism for this interaction is dolutegravir's organic cation transporter 2 inhibition, which primarily eliminate metformin, requiring monitoring and dose restriction of metformin
November 20, 2025 at 10:34 PM
#OTILT Dolutegravir, an INSTI for HIV, may increase the serum level of metformin when used concomitantly. One possible mechanism for this interaction is dolutegravir's organic cation transporter 2 inhibition, which primarily eliminate metformin, requiring monitoring and dose restriction of metformin
#OTILT In patients who have received lung transplant surgery, trimethoprim-sulfamethoxazole must be given routinely for pneumocystis jirovecii pneumonia prophylaxis for 6 to 12 months. Given the delayed onset of PJP, TMP-SMX is often initiated a few days after other prophylactic agents.
November 20, 2025 at 12:22 AM
#OTILT In patients who have received lung transplant surgery, trimethoprim-sulfamethoxazole must be given routinely for pneumocystis jirovecii pneumonia prophylaxis for 6 to 12 months. Given the delayed onset of PJP, TMP-SMX is often initiated a few days after other prophylactic agents.
#OTILT The combination of amphotericin B and posaconazole is a debatable topic. Although there are multiple studies that show the synergistic effect of the combination, their mechanisms inherently counteract each other as posaconazole decreases ergosterol synthesis while amphotericin B binds to them
November 18, 2025 at 10:01 PM
#OTILT The combination of amphotericin B and posaconazole is a debatable topic. Although there are multiple studies that show the synergistic effect of the combination, their mechanisms inherently counteract each other as posaconazole decreases ergosterol synthesis while amphotericin B binds to them
#OTILT The management of complex orthopedic infections often indicate prolonged course of antimicrobial therapy up to 6 weeks. The OVIVA Trial compared outcomes (definitive treatment failure within 1 year after randomization) of oral vs intravenous, and suggested non-inferiority of oral antibiotics.
November 17, 2025 at 8:42 PM
#OTILT The management of complex orthopedic infections often indicate prolonged course of antimicrobial therapy up to 6 weeks. The OVIVA Trial compared outcomes (definitive treatment failure within 1 year after randomization) of oral vs intravenous, and suggested non-inferiority of oral antibiotics.
#OTILT Budesonide gets metabolized by CYP3A4, and voriconazole is a strong CYP3A4 inhibitor. This leads to a DDI, where serum budesondie level increases, causing ADEs like Cushingoid. It's suggested to either consider alternatives or monitor for increased corticosteroid adverse effects if combined.
November 14, 2025 at 10:42 PM
#OTILT Budesonide gets metabolized by CYP3A4, and voriconazole is a strong CYP3A4 inhibitor. This leads to a DDI, where serum budesondie level increases, causing ADEs like Cushingoid. It's suggested to either consider alternatives or monitor for increased corticosteroid adverse effects if combined.
#OTILT The treatment duration for CoNS bacteremia commonly ranges from 5 to 7 days according to the 2009 IDSA guidelines on intravascular catheter-related infection. A study by Thomas L Holland et al. highlights the non-inferiority of algorithm-based treatment in comparison to unrestricted care.
November 13, 2025 at 10:58 PM
#OTILT The treatment duration for CoNS bacteremia commonly ranges from 5 to 7 days according to the 2009 IDSA guidelines on intravascular catheter-related infection. A study by Thomas L Holland et al. highlights the non-inferiority of algorithm-based treatment in comparison to unrestricted care.
#OTILT Staphylococcus epidermidis is a type of coagulase-negative staphylococci that is a leading cause of bacteremia. However, it is also the most common contaminant. Hence, antimicrobial therapy may not be warranted unless fever/bacteremia persists after catheter withdrawal.
November 12, 2025 at 10:27 PM
#OTILT Staphylococcus epidermidis is a type of coagulase-negative staphylococci that is a leading cause of bacteremia. However, it is also the most common contaminant. Hence, antimicrobial therapy may not be warranted unless fever/bacteremia persists after catheter withdrawal.
#OTILT Accelerated veno-venous hemofiltration (AVVH) is a type of hemodialysis with a higher filtration rate (8-10 hours) in comparison to continuous veno-venous hemofiltration (CVVH) (24 hours). This affects the PK/PD of antibiotics, and the dosing should be adjusted accordingly.
November 10, 2025 at 4:53 PM
#OTILT Accelerated veno-venous hemofiltration (AVVH) is a type of hemodialysis with a higher filtration rate (8-10 hours) in comparison to continuous veno-venous hemofiltration (CVVH) (24 hours). This affects the PK/PD of antibiotics, and the dosing should be adjusted accordingly.
#OTILT Vancomycin is an antimicrobial agent well-known for its nephrotoxicity. However, although not common, hepatotoxicity could occur in some cases leading to DRESS syndrome or elevations in ALT/AST levels.
November 7, 2025 at 8:00 PM
#OTILT Vancomycin is an antimicrobial agent well-known for its nephrotoxicity. However, although not common, hepatotoxicity could occur in some cases leading to DRESS syndrome or elevations in ALT/AST levels.
#OTILT One commonly known side effect of fluoroquinolone is QTc prolongation. Moxifloxacin inhibits the human ether-a-go-go-related gene (hERG) potassium channel, which involves Tyr652 residue that participates in moxifloxacin binding to the channels
November 7, 2025 at 2:07 AM
#OTILT One commonly known side effect of fluoroquinolone is QTc prolongation. Moxifloxacin inhibits the human ether-a-go-go-related gene (hERG) potassium channel, which involves Tyr652 residue that participates in moxifloxacin binding to the channels
#OTILT Delafloxacin is a 4th-gen fluoroquinolone with a broad antimicrobial coverage. One study found potential for delafloxacin + tobramycin combination in cystic fibrosis due to its increased activity against Pseudomonas in comparison to other available agents (i.e. ciprofloxacin, levofloxacin)
November 5, 2025 at 8:51 PM
#OTILT Delafloxacin is a 4th-gen fluoroquinolone with a broad antimicrobial coverage. One study found potential for delafloxacin + tobramycin combination in cystic fibrosis due to its increased activity against Pseudomonas in comparison to other available agents (i.e. ciprofloxacin, levofloxacin)
#OTILT Mavyret (glecaprevir/pibrentasvir) is a substrate of P-gp and hepatic transporter OATP1B1/3. Due to this pharmacokinetic profile, co-administration of Mavyret with atorvastatin should be avoided. However, concomitant use of rosuvastatin is safe as long as the dose does not exceed 10mg.
November 4, 2025 at 8:01 PM
#OTILT Mavyret (glecaprevir/pibrentasvir) is a substrate of P-gp and hepatic transporter OATP1B1/3. Due to this pharmacokinetic profile, co-administration of Mavyret with atorvastatin should be avoided. However, concomitant use of rosuvastatin is safe as long as the dose does not exceed 10mg.
#OTILT Dalbavancin is a long-acting lipoglycopeptide antibiotic with emerging evidence of its efficacy for bacteremia and endocarditis. In one study with an in-silico simulation for new dosing regimen (1.5g on days 0 and 21, or 1g on day 0 + 500mg on days 0 and 8), promising PK/PD profile was shown.
November 3, 2025 at 7:37 PM
#OTILT Dalbavancin is a long-acting lipoglycopeptide antibiotic with emerging evidence of its efficacy for bacteremia and endocarditis. In one study with an in-silico simulation for new dosing regimen (1.5g on days 0 and 21, or 1g on day 0 + 500mg on days 0 and 8), promising PK/PD profile was shown.
#OTILT Cefepime is known as an antimicrobial therapy with a broad spectrum coverage. However, it does not have a reliable susceptibility for treating Ainetobacter ursingii infections. One retrospective study reports about 42% intermediate susceptibility or resistance for cefepime.
November 1, 2025 at 12:40 AM
#OTILT Cefepime is known as an antimicrobial therapy with a broad spectrum coverage. However, it does not have a reliable susceptibility for treating Ainetobacter ursingii infections. One retrospective study reports about 42% intermediate susceptibility or resistance for cefepime.
#OTILT In patients with HIV, pneumocystis jiroveci pneumonia (PJP) chemoprophylaxis should be initiated when CD4 count is below 200. If the CD4 drops below 100 and the patient is seropositive for Toxoplasma, chemoprophylaxis for Toxoplasma gondii should be initiated with TMP/SMX or atovaquone.
October 31, 2025 at 12:31 AM
#OTILT In patients with HIV, pneumocystis jiroveci pneumonia (PJP) chemoprophylaxis should be initiated when CD4 count is below 200. If the CD4 drops below 100 and the patient is seropositive for Toxoplasma, chemoprophylaxis for Toxoplasma gondii should be initiated with TMP/SMX or atovaquone.
#OTILT Cefiderocol mimics siderophore, an iron-chelating molecules from bacteria that facilitates iron transportation into the cell for bacterial growth, with its C-3 side chain with the chlorocatechol group. This siderophore mechanism helps the drug overcome bacterial resistance like efflux pump.
October 29, 2025 at 10:21 PM
#OTILT Cefiderocol mimics siderophore, an iron-chelating molecules from bacteria that facilitates iron transportation into the cell for bacterial growth, with its C-3 side chain with the chlorocatechol group. This siderophore mechanism helps the drug overcome bacterial resistance like efflux pump.
#OTILT Tenofovir alafenamide fumarate (TAF) is associated with weight gain in comparison to Tenofovir disoproxil fumarate (TDF). However, TDF is associated with higher renal toxicity and decreased bone marrow density. These features should be considered to assess risk/benefits when choosing an ART.
October 28, 2025 at 6:23 PM
#OTILT Tenofovir alafenamide fumarate (TAF) is associated with weight gain in comparison to Tenofovir disoproxil fumarate (TDF). However, TDF is associated with higher renal toxicity and decreased bone marrow density. These features should be considered to assess risk/benefits when choosing an ART.
#OTILT TMP-SMX, doxycycline, linezolid, and clindamycin target MRSA as oral antibiotics. However, patients who have injection use disorder may face complications like DDIs (serotonin syndrome), renal dysfunction, infection risk, and difficulty in achieving therapeutic goal when using these agents.
October 27, 2025 at 6:09 PM
#OTILT TMP-SMX, doxycycline, linezolid, and clindamycin target MRSA as oral antibiotics. However, patients who have injection use disorder may face complications like DDIs (serotonin syndrome), renal dysfunction, infection risk, and difficulty in achieving therapeutic goal when using these agents.
#OTILT Daptomycin is Cmax-dependent while vancomycin is AUC-dependent antibiotics. This explains the dosing convenience daptomycin has over vancomycin, a large once daily dose for standard daptomycin treatment. On the other hand, vancomycin comes with more monitoring burden than daptomycin.
October 24, 2025 at 10:22 PM
#OTILT Daptomycin is Cmax-dependent while vancomycin is AUC-dependent antibiotics. This explains the dosing convenience daptomycin has over vancomycin, a large once daily dose for standard daptomycin treatment. On the other hand, vancomycin comes with more monitoring burden than daptomycin.
#OTILT Desirability of outcomes ranking/response adjusted for duration of antibiotic risk (DOOR/RADAR) study design aims to overcome methodological limitations of using traditional single-binary outcomes. It creates a single score, including multiple outcomes, that evaluates both harms and benefits.
October 23, 2025 at 9:50 PM
#OTILT Desirability of outcomes ranking/response adjusted for duration of antibiotic risk (DOOR/RADAR) study design aims to overcome methodological limitations of using traditional single-binary outcomes. It creates a single score, including multiple outcomes, that evaluates both harms and benefits.
#OTILT Doxycycline is not commonly used for UTI due to its route of elimination via the intestinal tract with limited urinary tract excretion. Moreover, there is limited evidence supporting its usage for bloodstream infections along with poor pharmacokinetic profile to reach therapeutic conc.
October 22, 2025 at 5:54 PM
#OTILT Doxycycline is not commonly used for UTI due to its route of elimination via the intestinal tract with limited urinary tract excretion. Moreover, there is limited evidence supporting its usage for bloodstream infections along with poor pharmacokinetic profile to reach therapeutic conc.
#OTILT Severe cellulitis can be classified as a case where the patient either fails oral antibiotics or experience systemic signs (i.e. temperature > 38°C, heart rate > 90 bpm, respiratory rate > 24, or abnormal white blood cell count (>12 000 or <400 cells/µL), or are immunocompromised.
October 21, 2025 at 6:52 PM
#OTILT Severe cellulitis can be classified as a case where the patient either fails oral antibiotics or experience systemic signs (i.e. temperature > 38°C, heart rate > 90 bpm, respiratory rate > 24, or abnormal white blood cell count (>12 000 or <400 cells/µL), or are immunocompromised.