Antibiotic Steward 🅱️C🆔🅿️🌟

This is worth talking about. Great study and a potential game changer. #cdiff #IDsky #medsky

Thanks
@drtoddlee.bsky.social meta on the way
The link is for the protocol, results of OpTION RCT in IDweek 2025 abstract
TAPER V2 will answer this question direct comparison taper V vs Fidaxomicin
clinicaltrials.gov/study/NCT073...

Defining optimal treatment for recurrent Clostridioides difficile infection (OpTION study): A randomized, double-blind comparison of three antibiotic regimens for patients with a first or second recur... Although many large, randomized controlled trials (RCT) have been conducted on antibiotic therapy for patients with primary C. difficile infections (C…

The recent OpTION study 2025 trial presented at ID week failed to show fidaxo was superior to Vanco 10 days at day 56
Whereas Vanco p-t was superior in TAPER V at day 56
@bradspellberg.bsky.social
www.sciencedirect.com/science/arti...

Defining optimal treatment for recurrent Clostridioides difficile infection (OpTION study): A randomized, double-blind comparison of three antibiotic regimens for patients with a first or second recur... Although many large, randomized controlled trials (RCT) have been conducted on antibiotic therapy for patients with primary C. difficile infections (C…

The recent OpTION study 2025 trial presented at ID week failed to show fidaxo was superior to Vanco 10 days at day 56
Whereas Vanco p-t was superior in TAPER V
www.sciencedirect.com/science/arti...

Defining optimal treatment for recurrent Clostridioides difficile infection (OpTION study): A randomized, double-blind comparison of three antibiotic regimens for patients with a first or second recur... Although many large, randomized controlled trials (RCT) have been conducted on antibiotic therapy for patients with primary C. difficile infections (C…

The recent OpTION study 2025 trial presented at ID week failed to show fidaxo was superior to Vanco 10 days at day 56
Whereas Vanco p-t was superior in TAPER V
www.sciencedirect.com/science/arti...

Stay tuned
TAPER V2
Vanco taper Vs Fidaxomicin
Vancomycin Taper to Prevent Recurrent Clostridioides Difficile (TAPER-V2)
Study Details | NCT07328971 | Vancomycin Taper to Prevent Recurrent Clostridioides Difficile | #Idsky
clinicaltrials.gov/study/NCT07328…

Right. But seems as good or better than fidaxo at a fraction of the cost.

Stay tuned
TAPER V2
Vanco taper Vs Fidaxomicin
Vancomycin Taper to Prevent Recurrent Clostridioides Difficile (TAPER-V2)
Study Details | NCT07328971 | Vancomycin Taper to Prevent Recurrent Clostridioides Difficile | #Idsky
clinicaltrials.gov/study/NCT07328…

@bradspellberg.bsky.social

Dr Spellberg commented on X is spot on here
"Agree. The K-M curve is striking and makes me wonder sincerely, would fidaxo actually have been superior in its original RCT if the follow up had been longer. Are we spending all that money for a short term benefit that evaporates over time?"

@drtoddlee.bsky.social

*All patients received 14d pulse of vanco (standardized at 125 mg orally 4 times a day at the time of recruitment) →taper (125 mg q12h ×7d,then 125mg q24h ×7d) vs placebo for management of CDI (first episode or recurrence).

Initial Vancomycin Taper for the Prevention of Recurrent C difficile Infection This randomized clinical trial tested whether a 4-week pulse and taper vancomycin regimen was superior to a 2-week pulse regimen for preventing recurrence among patients with a first episode or first ...

🔥Just published 🔥
TAPER-V RCT
In this RCT of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to a standard 2-week pulse regimen in patients a first episode or first recurrence of CDI
Vanco for 10d is obsolete! #IDSky #EMIMCC
jamanetwork.com/journals/jam...

Important to add
*: With the exception of patients with severe anaphylaxis (e.g. anaphylactic shock), in which case the panel recommends seeking expert evaluation first #idsky

#IDSky #bookmark

🔥Just published 🔥
ESCMID Clinical Guidelines on the Evaluation and Management of a Reported Antibiotic Allergy #IDSjy
www.clinicalmicrobiologyandinfection.org/article/S119...

Wow, finally! #idsky

Promotional Toolkit ESCMID Global (formerly ECCMID): an annual congress bringing together experts and specialists in Clinical Microbiology and Infectious Diseases.

With ESCMID Global quickly approaching!
To help you spread the word and get involved, check out ESCMID Global 2026 Promotional Toolkit
The official hashtag for the congress this year is #ESCMIDGlobal2026 on all social media channels. #IDSky
www.escmid.org/congress-eve...

Thank you my friend! Based on your original work!!!!
US docs gotta get on board & stop pretending things that work in other countries won't work in US. AMBITION protocol is MUCH safer and MUCH more patient centered, and just as effective as 2 weeks of old, sad, amphoterrible. @absteward.bsky.social

Thank you @angelahuttner.bsky.social for a peak behind the curtain, your transparency on the editorial process, and for being critical of the publication process. We need more of this for there to be change!

This is sad!! #idsky

The beating heart of a broken machine

"The other evening,I received 2 normally welcome email alerts.The 1st informed me that an invitation to peer review had been accepted;the 2d,that a peer review had just been completed
The problem?These 2 emails came 7 minutes apart & concerned the same reviewer"
www.sciencedirect.com/science/arti...

As 2025 comes to a close, it has been another remarkable year for ID research. From groundbreaking vaccine studies to innovative antibiotic strategies and simplified TB regimens,this year has delivered insights that challenge dogma,refine clinical practice & advance global stewardship efforts #idsky

Thanks for the shout out my friend #idsky 😀

🎖️📄Top infectious disease journal articles from 2025 is out! May be good for a quick review to see if you missed anything or if you need to pick a journal club article. #pharmacist #infectiousdiseases #pharmacyschool #FYP #IDstewardship @absteward.bsky.social

www.idstewardship.com/year-in-revi...

Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis | NEJM Tuberculous meningitis is often lethal, and many survivors have disabilities despite antimicrobial treatment and adjunctive glucocorticoid therapy. Standard-dose rifampin has limited central nervou...

🆕⚡🧠HARVEST TRIAL:More Rifampin,Same Fate: High-Dose Rifampin Fails to Shift the Needle in TB Meningitis,NEJM,2025
Despite better theoretical CNS penetration,high-dose oral rifampin did not improve survival in adult TB meningitis & potential harm cannot be excluded #idsky
www.nejm.org/doi/full/10....

Comparative effectiveness of adjunctive rifampicin versus gentamicin for prosthetic valve endocarditis due to Staphylococcus aureus AbstractBackground. Although adjunctive rifampicin and/or gentamicin have been recommended for Staphylococcus aureus prosthetic valve endocarditis, evidenc

⚡🫀 Beyond Dogma: Battle of the Unproven: Rifampicin vs Gentamicin in Staph PVE — A Shot in the Dark, JAC-AMR, 2025
🔥 Key findings:
• ⚰️ Lower 1-year mortality with rifampicin: 31.3% vs 39.9% (HR 0.71; 95% CI 0.54–0.94) #IDSky #EMIMCC
academic.oup.com/jacamr/artic...

A New Era for Gonorrhea
FDA Approves Two Oral Therapies for the treatment of Uncomplicated Urogenital Gonorrhea ,December 2025.
✅Nuzolvence (Zoliflodacin) granules that dissolve in water
✅Blujepa (Gepotidacin) oral tablets

Cost?
Resistance? #IDSky #EMIMCC

FDA Approves Two Oral Therapies to Treat Gonorrhea The U.S. Food and Drug Administration recently approved two new oral medicines to treat a common sexually transmitted infection called gonorrhea.

FDA approval 📢🔥
US FDA approved Nuzolvence (zoliflodacin) granules that dissolve in water. This medicine can treat uncomplicated urogenital gonorrhea in adults and children 12 years and older who weigh at least 77 pounds.
2 new oral Abx for gonorrhea #idsky
gepotidacin
www.fda.gov/news-events/...

FDA approval 📢🔥
U.S. FDA.has approved **Blujepa (gepotidacin)**, a first-in-class oral antibiotic, for the treatment of **uncomplicated urogenital gonorrhoea in adults & adolescents aged 12 and older weighing at least 45 kg #IDsky #EMIMCC
www.reuters.com/business/hea...