Dan Landry

ACOG reaffirms that acetaminophen is safe for managing pain and fever during pregnancy. No reputable studies support suggestions like those in HHS’s recent announcement linking acetaminophen use in pregnancy to autism; in fact, high-quality studies show no such risk. https://bit.ly/47Wxc59

The planets aligned this week
#StewardshipSatisfaction

In the latest video in our partnership with @glaucomflecken.bsky.social, the BALANCE trial comparing 7 days of antibiotic treatment with 14 days of treatment in patients with bloodstream infection is explained. Access the article for free: nej.md/DrG19

Gold “just make a decision”

What’s the optimal cefazolin dose for MSSA CNS infections?
New PK/PD data says: it’s not just about higher doses—MIC matters.
2g q6h works only if MIC <=0.5 mg/L
For MIC:1-2 mg/L, continuous infusion (10–12g/day) may be needed to hit PD targets #idsky
journals.asm.org/doi/10.1128/...

2025 has been..... interesting....so far

a man in a suit is carrying three boxes of pizza into a doorway . ALT: a man in a suit is carrying three boxes of pizza into a doorway .

Opened Twitter for the first time in weeks today. This summarizes my experience:

Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection | NEJM Influenza A(H5N1) viruses are an emerging zoonotic threat and have spread widely throughout birds in North America. Recently, influenza A(H5N1) infection led to serious illness in a teenager in Canada.

So the kid in BC with H5N1 was very sick to the point of needing ECMO. While the majority of human cases have not been severe, this virus has the potential to be as bad as other H5N1s.

At population scale, even infrequently, this is millions of people.

www.nejm.org/doi/full/10....

How accurate is ceftriaxone at predicting susceptibility of enterobacterales isolates to oral higher-generation cephalosporins? | Antimicrobial Agents and Chemotherapy There is a growing body of evidence supporting early transition to oral antibiotic therapy to complete treatment courses for gram-negative bloodstream infections (GN-BSI) (1–3). Most available data fo...

Happy New Year, @absteward.bsky.social style! 🎉
Kicking off 2025 with this gem:
🆕💫 How accurate is ceftriaxone at predicting susceptibility of enterobacterales isolates to oral higher-generation cephalosporins? #idsky #EMIMCC
journals.asm.org/doi/10.1128/...

I had heard the same, but don't know much other than that

Yeah I've heard that one too... although another person was saying they thought a submission was sent in to Health Canada almost a year ago.
If that's true, not sure what the holdup is...

a woman is smiling while sitting in a car with her eyes closed ALT: a woman is smiling while sitting in a car with her eyes closed

Me reading posts about polio #IDSky #PharmSky

It's that time of year again. Here are my top 10 ID papers of 2024
1. My opinion
2. Practice changing, paradigm-shifting or dogma challenging
3. Not COVID
4. Alphabetical order by first author
5. CoI for 4 and 5 (I am an author)
Summary slide here, details in thread
#IDSky #Top10IDpapers

"Disney princesses face serious real world health
hazards. Surprisingly, however, despite these risks
they seem to live happily ever after!" 👸

Another BMJ Christmas Special!👇

www.bmj.com/content/387/...

#medsky #pharmsky #nursesky #GPsky #MedEd

The great irony of this is that the incredible success of vaccinations allows for the skepticism of them. If these diseases were common and we saw vaccines preventing severe diseasen in vaccinated people and deaths in unvaccinated people, there wouldn’t be a question. 1/

This is a lie. And it’s an abhorrent lie because the goal of this lie is to prevent polio vaccination and kill even more people.

Yeah exactly. Our site has also integrated IVP cefazolin in our dialysis unit for post-HD doses (less chair time being wasted)

📋👀 Did you miss any of these articles from 2024?

📲 www.idstewardship.com/year-review-...

#IDsky with @absteward.bsky.social

I'd say reduced nursing time is certainly a good thing, as the nursing staff here is already overburdened.
Another area where IV-push is great for operational reasons would be for pre-op surgical prophylaxis, to ensure folks get it at the right time

Health insurance industry PR is working overtime right now diverting blame to physicians for claim denials and rising costs. I feel compelled to remind everybody that Optum (UHC) is the largest employer of physicians in the US. We have never had less power in healthcare than we do right now.

Year In Review: Top Infectious Diseases Articles From 2024 In this article a selection of notable peer-reviewed publications from 2024 are provided. Article Selection by: Bassam Ghanem, Pharm.D., MS, BCPS Article Construction by: Timothy P. Gauthier, Pharm.D....

🔥🔥 NEW 🔥🔥
Year In Review: Top Infectious Diseases Articles From 2024
Our new post, a great collaboration with my friend
🌟 @idstewardship.bsky.social
1️⃣6️⃣⚡️🆔 RCTs
7️⃣Syst Reviews/Meta
3️⃣🌏Guidelines ✨️Wiki_Guidelines
#idsky #EMIMCC #medsky #utisky
EnJoy
Share plz!
www.idstewardship.com/year-review-...

Pharmacodynamic studies indicate that anaerobic killing is optimized when the plasma AUC) to MIC ratio is ≥70:1; the probability of achieving this target with 1000mg/d of metronidazole is > 99% against B. fragilis that exhibit MICs < 2mg/L #idsky #medsky #EMIMCC

My eyes immediately went to the 30° temps....and then realized it was in °F (and not °C)
#CanadaProblems

viral cell entry

When you're trying to decide between PO/IV in the vast majority of hemodynamically stable patients (tolerating oral intake), these are essentially the options you're weighing!

#ID #IDmemes #AMS

Golden rules by @bradspellberg.bsky.social
1️⃣🌟There is nothing magical about IV antibiotics.
2️⃣🌟There's no magical infectious disease that requires IV antibiotic treatment.
3️⃣🌟There is NO minimum required IV lead-in duration
IV "lead in" is a myth #idsky #medsky #EMIMCC

Tmp-Smx dose seems a bit high, I'd echo others who said to drop the dose. I wouldn't automatically go with PJP doses.

If source control is achieved (seems to be from what I understan), I don't see a reason to go avoid PO options. So Levo (or mino) would be other options IMHO

YouTube video by Dr. Glaucomflecken No More General Anesthesia

One thing I didn’t expect in the wake of the CEO shooting is the sudden attention on health insurance policy. I have seen this video and the BCBS policy itself go viral on almost every platform. People are waking up. Real lasting change in healthcare is coming. youtube.com/shorts/vWA2a...

The studies by @ericmacymd.bsky.social and colleagues on populations of millions of patients have been great at separating that aspect. They've shown it's safe to give cephalosporins to patients with penicillin allergy (irrespective of side chain similarities).

2/2