🚨A new study by incoming fellow Dr. Okuno, mentored by faculty Dr. Boulware and Dr. Bahr, evaluates the association between therapeutic LPs and survival in patients with Cryptococcal Meningitis.
The Findings: repeat LPs are a life-saving intervention across diverse patient populations. #IDSky
MMWR this week covering the New Mexico measles outbreak and urging vaccination…
www.cdc.gov/mmwr/volumes... #IDSky
That said when policy or implementation disadvantages health access to a majority of people you might see or provide care to I don’t see why it would be wrong to say this is not fair or appropriate, when asked
Ah. What a disaster. This is like back to the past. #HIV #harmreduction kffhealthnews.org/news/article...
Proof to start to abandon this practice academic.oup.com/cid/advance-...
I love how GPT turns Amelia Bedelia in converting random value to irregular esteem....:-) #medsky www.nature.com/articles/d41...
Their nearly total freedom to determine the context of their professional activities and their own standards within this context, especially in the private office where much of medicine is practiced, precludes any rational conviction about the effects of their efforts.”
“To say that physicians are good or bad would be to imply that there are well-accepted standards of performance and random audits to judge them by; but there are none.
Great piece @patrickching.bsky.social
I guess these are imprinted beliefs, with overwhelming
motivation to be contrarian as against questioning ourselves , difficult to reason with.
I remember reading Kary Mullis’ foreword to that book and it is fascinating how when people become obsessed with an idea beyond its individual merit they become ego defensive feeding their own confirmation biases
Agree @paulsaxmd.bsky.social . I wish more people would sign up
You should apply to write questions for the ABIM. They need question writers.
A third generation cephalosporin found its way into the #nytimes puzzle section today #IDsky #medsky
Correction 1.2MU
➡️Can we do 2 doses instead of 3?
➡️More importantly, what is late latent syphilis in PLWHIV? Is it one year? 6 months? No prior titers?
➡️With Benzathine penicillin shortages, I think this is not moot.
So what can we conclude?
➡️The 3-dose late latent syphilis regimen is built on an assumed treponemicidal level.
➡️ There is no data about this dosing in the HIV era!!
➡️There are differences in PCNG levels in young vs old populations. (PCN is renally excreted). Perhaps one dose is ok in older pts?🤔
In CA/MD when there was inadvertent administration of Bicillin CR instead of Bicillin LA treatment failure rates were not significantly different between patients despite Bicillin CR containing only half the recommended dose of benzathine penicillin G pmc.ncbi.nlm.nih.gov/articles/PMC...
More recent PK simulations suggest levels may dip below 0.02 µg/mL around 2 weeks — but those models often use 1.2 MU, not the 2.4 MU dose used for syphilis (PMID 25182635)
PK data for BPG:
• Young adults, single 2.4 MU dose:
– 0.2 µg/mL at 48h--> – 0.05 µg/mL at 6 days-->– 0.02 µg/mL at ~13 days. Elderly adults, same dose:
– ~0.04 µg/mL still present at 20 days
So a single 1.2MU BPG dose maintains “rheumatic-fever-level” penicillin for ~2–3 weeks, depending on age.
To anchor this to something better studied: rheumatic fever prophylaxis.
For decades, the accepted minimum effective penicillin level to suppress group A strep is ~0.02 µg/mL.
→ That’s why BPG is dosed every 4 weeks, with q3-week dosing only in higher-risk populations.
What is a “treponemicidal” level of penicillin?
No one actually knows.
Older literature (PMID 20604419) assumed a penicillinemia of ~0.03 IU/mL (~0.02 µg/mL) — described vaguely as “several times the serum and tissue levels needed to kill T. pallidum.” This was assumed to be an "insurance" dose
The 3-dose regimen for late latent syphilis rests on remarkably thin evidence.
The logic: organisms dividing more slowly in long-standing infection require prolonged treponemicidal penicillin levels → hence weekly benzathine penicillin G (BPG) ×3.
Resetting to the realm of distributed authority needs doctors to focus on healer role and not someone with expertise alone
#IDsky has anyone used emocha like vDOT for HIV pill adherence/accountability in a SDM framework? #HIV. Any success or logistical challenges?
This paper investigates how resistance to antibiotics used for simple UTIs affects the resistance rate to antibiotics used to treat pyelonephritis:
doi.org/10.1093/jaca...
#JACAMRNews #IDSky
#IDsky has anyone used emocha like vDOT for HIV pill adherence/accountability in a SDM framework? #HIV. Any success or logistical challenges?
#IDsky
Thank you @mdhealthdept.bsky.social
