Yeah I’m with you. We did the stewardship intervention cuz it was so commonly inappropriately ordered.

You mean, something like this?

www.cambridge.org/core/journal...

Oh, well if it’s the blue alien dudes from avatar then yeah i get your point. All available evidence indicates that amphotericin causes them to turn green (cuz, yellow + blue = green). And green, as everyone knows, is good.

I know some folk think it shouldn’t be used for gatti. I can’t imagine why. Gatti doesn’t have higher fluc mics. It isn’t harder to kill. It’s more inflammatory & prone to infection in hiv-neg pts. Why would that mean AMBITION won’t work? Burden of proof is on the more harmful Tx, not the safer one.

Yup! Have a pint buddy!

0 reason to think things would be difft in non HIV, children, xenomorphs, non carbon based life forms, or any other excuses stubborn deniers have. My suggestion? Do some yoga. Meditate. Light incense. Relax. And stop torturing your patients with 2 weeks of amphoterrible. Subtle as always, I know.

0 reason to think things would be difft in non HIV, children, xenomorphs, non carbon based life forms, or any other excuses stubborn deniers have. My suggestion? Do some yoga. Meditate. Light incense. Relax. And stop torturing your patients with 2 weeks of amphoterrible. Subtle as always, I know.

Patient-directed discharges (i.e. leaving against medical advice) dropped from 35% to 12%.

Major congratulations to the authors: Devin Clark,
Brad Spellberg @bradspellberg.bsky.social , and colleagues.

In an excellent study of real world outcomes in LA General Medical Center, after implementing AMBITION single dose liposomal amphotericin protocol for crypto meningitis:
Similar survival without recurrence
Fewer severe adverse events
Shorter hospitalization (lower cost)
dx.doi.org/10.1001/jama...

As above, I’m good with mono therapy linezolid

I’m fine with oral linezolid as mono therapy. I do tend to use dual for others (amox+rif, amox+FQ, FQ+rif). But that’s cuz I’m chicken. Not because I’m really sure it’s needed.

Do you remember those old beer commercials? “Why ask why? Try Bud Dry.”

All this isolation stuff is non evidenced based nonsense. Cluster randomized trials have shown it doesn’t work. We no longer isolate for MRSA.

No the patients got variable days of IV. But no relationship between number of days of IV prior to oral fosfo and outcomes.

Not for me, no. I’d want source control of course.

Yes there are 2 published observational studies. 1 from our group. Both were cUTI but both had bacteremia it’s described.

Highly recommend you check out @bradspellberg.bsky.social book "Broken, bankrupt and dying". Achieving universal coverage can be done in many different ways. The rest of the developed world has done it in all different ways (government coverage, private/public, state subsidized etc).

Full blown dementia with psychosis can be quite entertaining when Im off my meds. Have a listen!