HIV and ID Observations

March 27th, 2024

Think Again Before Sending Your Patient Home on Intravenous Vancomycin

I took care of a patient many years ago with MRSA. The severity of the infection required a prolonged treatment course, and vancomycin was the default option. Cripes, it was the only option. He ultimately was discharged on home IV therapy, and as usual we had a plan to monitor his renal function and vancomycin […]

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March 16th, 2023

Oral Antibiotic Therapy for Endocarditis — Are We There Yet?

Two terms in clinical research appear frequently in abstracts, conference presentations, and published papers — “clinical practice” and more recently, “real-world.” Many research snobs turn up their noses at both, finding them imprecise or pretentious. I confess to flinching each time I read “real-world” — isn’t everything “real-world”? If not, what’s the opposite? Mouse studies? (They’re […]

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February 3rd, 2019

An “Interview” with the OVIVA Study of Oral vs. IV Antibiotics for Osteomyelitis

An “interview” inspired by publication of a landmark clinical trial. All responses written by me — but be assured, they are based on reading the paper, the accompanying editorial, the supplemental appendix, hundreds of comments on Twitter (some of them from the study investigators), and even a few generous comments from the the senior author in […]

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February 19th, 2018

Can We Solve the Morass of Outpatient Intravenous Antibiotic Therapy?

If you want to get an ID doctor riled up, here are a few reliable strategies: Get an ID consult on a complex patient just to summarize the chart for your discharge summary. Endorse the view that procedural doctors deserve their vastly higher salaries than MDs in cognitive specialties. Prescribe azithromycin for patients with bad colds. […]

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August 20th, 2017

Two Quick Thoughts Inspired by Inpatient ID Consults, and An Inspirational Baseball Poster

A couple of quick thoughts for those of us doing inpatient care these days: Thought One:  Is daptomycin now preferred over vancomycin in most clinical settings?  It’s taken a while, but we’re getting there — close to that Gladwelllian “tipping point”.  Allow this recap of vancomycin’s problems: The growing recognition that higher drug levels — the levels we […]

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September 7th, 2013

FAX machines, and the Special Power of the MD Degree

Everyone hates mindless paperwork. But certain types are particularly annoying, seemingly designed to send you screaming into the night, dragging a broken fax machine behind you as your brain explodes. Too strong? Take a look at this fax cover sheet I recently received about a patient who had been receiving IV antibiotics at home: To get at the […]

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