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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April 22nd, 2019

Two New Trials of Combination Therapy for MRSA Bacteremia Answer Some Questions — and Raise Several New Ones

Every clinically active ID specialist, hospitalist, and cardiologist realizes that treatment of bacteremia due to methicillin-resistant Staph aureus (MRSA) is no easy task. In fact, it’s a problem so difficult that persistent bacteremia due to MRSA deserved highlighting here as an “Unanswerable Problem in Infectious Diseases”. I wrote that over 5 years ago, and you know what? […]

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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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May 7th, 2012

Difficulties and Differences on C difficile

Some things in our field — diseases, treatments, generalizations, cliches, fads — have really changed since back in the early 1990s, when I started in this business. Here are a few that quickly come to mind: “Double coverage” of pseudomonas with a beta lactam plus an aminoglycoside was de rigueur MRSA was an inpatient concern only You […]

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March 31st, 2010

C diff Guidelines: Metronidazole Still Preferred?

IDSA and The Society for Healthcare Epidemiology of America (SHEA) have published Clinical Practice Guidelines for Clostridium difficile infection. Not surprisingly, it’s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old. But with the caveat that I’m not an expert in this area, these particular treatment recommendations […]

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March 14th, 2010

MRSA Bacteremia Question Redux — and the “Answer”

As noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking. (For more on that joyous process, read this interesting debate here in the New England Journal of Medicine.) The question seemed to have no obvious right answer, so I did what one is explicitly allowed to […]

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March 5th, 2010

Test Question on MRSA Bacteremia

I just happened to be taking a test the other day — something I do for fun every now and then, say every 10 years or so — and I came across this question (slightly condensed/changed to protect the innocent): Man with history of IDU admitted with fever, has bacteremia due to MRSA (MIC 2 mcg/mL […]

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