Brad Spellberg

Rock on my brother in ampho-hating!
@drboulware.bsky.social

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.

And a congratulations to the humble @drboulware.bsky.social, who published a thoughtful editorial accompanying the study. Dr. Boulware is a true leader in ID, and it is an honor to have him evaluate our study. I encourage everyone to read his team's editorial!
jamanetwork.com/journals/jam...

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

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...

Single-Dose Amphotericin B for HIV-Related Cryptococcal Meningitis Cryptococcal meningitis remains a life-threatening opportunistic infection among people with advanced HIV, even in high-resource settings. For decades, the standard induction regimen in the United Sta...

Is It Time to Use Single-Dose Amphotericin B for HIV-Related Cryptococcal Meningitis in the USA?

The answer is yes!
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.

Behind the scenes 🔥🔥 with all the laughs on the latest Febrile Podcast @febrilepodcast.com with @lageneral-id.bsky.social and @bradspellberg.bsky.social #IDSky

player.captivate.fm/episode/dd68...

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).

Hasn't been much discussion of the 40% failure rate to fill ID programs this match year. Interesting. Wonder if anyone is ever going to do anything about that?

🆕🎙️🔥Febrile Podcast just dropped!
✅ID Jedi @bradspellberg.bsky.social
✅Mini-cases OM,IE,Bacteremia
✅IV vs PO debates
✅Duration of therapy
✅Shmidelines Vs WikiGuideline
✅A must-listen for every antibiotic steward! #IDsky #EMIMCC
febrilepodcast.com/episodes/
open.spotify.com/episode/6dkJ...

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

New episode out today: Listen in to this team from LA as they walk through several mini-cases and chat IV vs PO antibiotics!

Feat: Fourth year medical student Hannah Chute, Dr. Paloma Reta-Impey, and @bradspellberg.bsky.social

Also check out: www.bradspellberg.com/oral-antibio...

#IDsky #MedSky

🆕🔥🦴 Our 2025 Update to @wiki-guidelines.bsky.social for the Management of Pyogenic Osteomyelitis in Adults 🌟 @bradspellberg.bsky.social
🔗 [link] #idsky
www.amjmed.com/article/S000...

Hospital Hemodialysis Unit Flexibility and Hospital Length of Stay This quality improvement study evaluates the association of hospital length of stay with a first-in-state model in which an inpatient hemodialysis unit received regulatory approval to provide temporar...

Thrilled that another regulatory innovation out of LA General is now out in @jamanetworkopen.com!

The first hospital in California authorized by CDPH to administer outpt hemodialysis for up to 2 weeks for inpatients newly started on HD who lack insurance.

jamanetwork.com/journals/jam...

No but what I’m saying is, many patients get vanco who don’t have meningitis at all. They get the vanco before the LP, and the LP is negative for meningitis. So the denominator is all LPs done to evaluate for meningitis including those that are negative.

Yes, we recommend adding vanco only for purulent meningitis, AFTER LP. One thing, there is no way 9% of LPs are S. pneumo. 9% of meningitis maybe. But vanco goes in before LP, so all those non meningitis LPs still got vanco and aren't counted in your calculations. I htink it's more lik 1 in 100 LPs.

If 1% of ED LPs end up being for Pneumo, and 1% of Pneumo in adults is R, you will do 10,000 vanco courses for every 1 patient with CTX-R pneumococcal meningitis. That will definitely cause a large amount of AKIs and VREs.
In LA, we recommend NOT adding vanco until LP CSF WBC/% PMN known.

Yup, posted on the other platform. For PK, 2 gm CTX Cmax blood 250 mcg/ml, 10% CSF = 25 at peak. 4-6 hr half life:
T0 = 25
T4 = 12.5
T8 = 6.25
T12 = 3.125 --should be above MIC whole interval.

As far as the massive overuse of vanco, does depend on geography. In much of US, CTX-R rare in adults...

📢📢📢 We are delighted to announce that we are assembling team for our next project, Pharyngitis WikiGuideline

Join us to create guidelines with the humility of uncertainty.

Deadline to sign up is November 21, 2025.