An ongoing dialogue on HIV/AIDS, infectious diseases,
June 10th, 2017
What’s Your Favorite Antibiotic? A Fantasy Draft
Over on the journal Open Forum Infectious Diseases (that’s “O-F-I-D”, not “Oh-FID”), the generous people from IDSA and Oxford University Press have allowed me to record a series of podcasts, interviewing various interesting people in the ID field.
This time, however, I strayed from the usual format and asked my colleague Rebeca Plank to join me in a “draft” of our 5 favorite antibiotics.
Which is emphatically not to imply that Rebeca isn’t interesting. On the contrary — she happens to have one of the most impressive pen collections in all of Eastern Massachusetts.
Still, you may wonder, why did we do this? Several reasons:
- We sensed a burning need for this this critical educational resource, which as you will see teaches fundamental truths about these important therapeutic tools.
- One of us wanted to honor the upcoming baseball draft (hint: Rebeca couldn’t care less about baseball).
- Someone gave me a USB microphone, and it was sitting around doing nothing for way too long.
In short, mostly we did it for fun.
Take a listen! And while you’re at it, two questions:
- What are your favorite antibiotics, and why?
- What should we draft next?
Meanwhile, many life lessons in this video:
https://twitter.com/iamjoonlee/status/873385285140307968
(H/T to Joe Posnanski and Michael Schur for the draft idea.)
20 Responses to “What’s Your Favorite Antibiotic? A Fantasy Draft”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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Chloramphenicol. OK, I now you don’t use it in the US, but we do. And it has a great coverage, both gram positive (including S. Aureus), gram negative and anaerobes.We tend to use it in critically-ill debilitated patients that you usually prefer not to intervene at all but forced to, while trying to avoid the ecological-collateral damage of cephalosporins (not to mention pip/taz or carbapenems). Aplastic anemia is the risk, which is quite rare especially if you treat IV. And it doesn’t cover pseudomonas or enterococci.
A very unconventional choice!
Not enterococci? I use chloramphenicol when in the tricky situation of loosing options for VRE.
I love all my antibiotics the same.
Absolutely brilliant! I can’t believe I listened to the whole thing.
Your opponent looks 12 years old.
Wow, such a great podcast. Perhaps my favorite moment was at the end when not only was the schoolyard bully Azithro left on the bench but the team captains couldn’t resist calling him out as the popular kid from the cool clique who just can’t play ball.
Doxy for sure. Good for what worries them in New England summertime
It may have been John Bartlett who said “doxycycline is the best antibiotic to use when you have to give an antibiotic to a patient who doesn’t need an antibiotic.”
Ceftriaxone. All the STD coverage Azithro/Doxy can’t buy, plus it’s a once-daily dose, so I get salaams from my overworked nurses.
I blaspheme against my lovely penicillins, I know. Florey forgive me.
But, proudest moment was in being able to treat a neutropenic fever with Ceftriaxone because it was Coag-neg Staph bacteremia (genuine, and downgraded from empirical).
No end of Oncology staff getting sweaty because of the patient’s absent hypo-carbapenem-emia.
Otherwise, Metronidazole. In part because it inexplicably makes me think of Brooklyn.
Strange days, but also Gershwin.
Trovafloxacin. One of the broadest spectrum antibiotics of all time. Gram negatives, gram positives, and Europeans….
Arsenic. For sure. Deadly curative.
Cefuroxime for sensitive staph
Augmentin for respiratory tract infections
Nitrofurantoin for UTI
Fluoroquinolones for gut infections
pipracilin tazobactum in sepsis
Fosfomycin. Because nobody’s ever heard of it, so I look like a genius; plus the patient avoids IV antibiotics. Also I like saying “sachet.”
My “Desert Island” antibiotic? Chloramphenicol hands down. Very broad coverage, including anaerobes, penetrates everywhere, and great levels when taken orally. Having used it in my early practice, and saved many lives in Africa using it, I miss it greatly. Aplastic anemia.. yes, but you only use it when the benefits outweigh the risks. And how many other drugs that we use, if known, have similar risks.
Wonderful podcast, perhaps the best that I have heard in a long time. I have shared the link with clinicians and lab colleagues.
Thank you!
Paul
These are great! Any chance the OFID webmaster can make a podcast feed for the site so I can subscribe with my favorite podcast app?
Thanks!
Thank you.
I really loved the podcast, really interesting opinions. I tried to make something like this but with vaccines, but my colleagues looked at me like I was the nerdiest person in the world.
Great podcast Dr. !