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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · 1d

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

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Aug 6

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

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Jul 29

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

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Jul 28

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

Reposted by Julian Ventres, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · Jul 24

we're under-utilizing aminoglycosides for urosepsis in patients with good renal function

rising % ESBL is pushing us to use carbapenems for empiric therapy... leading to more resistance (CDiff, CRE)

aminoglycosides have minimal gut penetration = low CDiff risk & protect microbiome 🧵 #1/4 #EMIMCC

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Jul 25

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

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Jul 23

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

Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Jul 4

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

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Jun 19

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!

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Jun 19

Looking for people that have unrestricted linezolid at their institutions. Any increases in resistance? Better to just ease up on use criteria? Currently reviewing our own usage and seeing what we can do with rising tetracycline resistance in S. aureus #IDSky #AMSky

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · May 30

Linezolid for odontogenic infections? Anyone doing this empirically? It feels like the data is there that LZD covers the relevant bugs, but there's no clinical data that I could find. Have to think LZD would be preferable to clinda #IDSky #AMSky

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · May 29

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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Reposted by Julian Ventres, PharmD BCPS

Contagion® @contagionlive.bsky.social · May 20

Innoviva Specialty Therapeutics’ antibiotic is the first and only FDA-approved cephalosporin indicated to treat Staphylococcus aureus bacteremia, including right-sided endocarditis, caused by the methicillin-resistant Staphylococcus aureus. #IDsky #Medsky

Ceftobiprole Launches Commercially in US

Innoviva Specialty Therapeutics’ antibiotic is the first and only FDA-approved cephalosporin indicated to treat Staphylococcus aureus bacteremia (SAB), including right-sided endocarditis, caused by th...

www.contagionlive.com

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · May 17

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · May 13

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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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · May 6

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Reposted by Julian Ventres, PharmD BCPS

BITSCOPIC @bitscopic.bsky.social · May 5

Derived from the PEN-FAST allergy decision tool, the CEPH-FAST version was developed and validated in this study. www.journalofinfection.com/article/S016...
#IDsky #pharmsky

Development and Validation of a Cephalosporin Allergy Clinical Decision Rule

Utilising the previously published and internationally validated tool PEN-FAST, we validated the same criteria with minor modifications for low-risk cephalosporin allergies. The results suggest that a...

www.journalofinfection.com

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · May 5

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · May 2

I also hate the term "broad". What is "broad" antibiotics? TMP/SMX is exceptionally broad imo, but I don't see people using that when they're saying broad coverage. Same goes for doxy and mino. More often than not it just means they're throwing stewardship to the wayside during empiric coverage

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Apr 24

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Apr 17

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Reposted by Julian Ventres, PharmD BCPS

Erin McCreary, PharmD @erinmccreary.bsky.social · Apr 12

@steventong.bsky.social presents the results of the PSSA domain of the SNAP 🫰 trial - the worlds largest trial of staph aureus bacteremia - at #ESCMID2025

fluclox resulted in higher mortality and more AKI compared to penicillin for PSSA

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Apr 11

Personally I still don't feel comfortable using mino or doxy for Tet-R, but have done it on occasion when there wasn't any other reasonable option. Bactrim performs much better on our antibiogram, and can usually swap to linezolid otherwise

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Apr 11

We had this discussion recently at my institution. Tetracycline only covered ~65% of our MRSA. We looked at some resistance databases to see what percent of Tet-R we could expect to be doxy or mino-S, only improved to like 75%ish. In the end we moved tetracycline to 2nd line for SSTI.

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Julian Ventres, PharmD BCPS @juliambisome.bsky.social · Mar 28

Not something I'm personally familiar with or read up on, but a quick search did bring up this paper which doesn't look promising for clinda. doi: 10.1093/clinids/23.4.718. PMID: 8909833.

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