Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you routinely recommend IVIG for viral myocarditis?
I do not routinely recommend IVIG for viral myocarditis. If there is a case of immune-mediated myocarditis) - It may be recommended. In cases of severe COVID myocarditis in the past, use has been reported. However, it is not something that I routinely recommend.
What is your preferred dosing of IV ganciclovir for CMV disease in immunocompromised patients?
For treatment, I usually start with 5 mg/kg IV q 12 hr, and the dose is adjusted for renal function with the help of ID pharmacists. I can consider going to 7.5 mg/kg if there is a concern for very severe disease or low-level resistance, but to be honest, I don't think I've ever done that, given the...
What is your approach to deciding when to stop therapy for cutaneous Mycobacterium chelonae infections?
I have an ongoing case of M abscessus cutaneous infection, possibly acquired from a pedicure. This is a similar bug to M chelonea, but even harder to treat. Our approach was to gather the opinion of several experts through email communication. The conclusion was to treat for 6-12 months, and follow ...
Is there a role for empiric scabies treatment in itchy patients without clear clinical signs of scabies?
I have seen many astute clinicians miss scabies or consider it after months of treating for AD with biologics and other systemics (including myself). Though this is very rare my personal rule of thumb is to treat with oral ivermectin if at any point patient is not responding the way I expect to trea...
When do you consider extended courses of oseltamivir in immunocompromised patients?
For immunocompromised individuals with severe influenza, I recommend a 10-day course of oseltamivir based on AST ID-COP guidelines (Manuel et al., PMID 30817023). Practically speaking, this is any immunocompromised patient who is hospitalized due to influenza.
What is your re-immunization strategy after auto SCT for patients with myeloma on dara/len maintenance?
We do the same vaccination sequence according to BMT/CTN, whether they are on maintenance dara or not. Here is our schedule Post autologous SCT vaccine Interval Date Vaccine Yearly Flu Vaccine 3-month post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap, Shingrix 6 months post-transplant Pneu...
Under which circumstances is there a role for reduction in immunosuppression post-SOT in a patient with recurrent CMV viremia and/or disease?
While the decision regarding immunosuppression is always up to the primary transplant team, as the infectious disease consultant, I always inquire about the ability to reduce immunosuppression during episodes of CMV syndrome or disease even if it is a first episode. This becomes even more important ...
How long do you treat uncomplicated gram-negative rod bacteremia in solid organ transplant recipients?
My approach to the duration of therapy for GNR bacteremia in SOT patients depends on the source of the bacteremia, the available antibiotics, the patient's net state of immunosuppression, and the organism. There are situations where 7 days of therapy are adequate (One example: E.coli urosepsis in a ...
How does trimethoprim-sulfamethoxazole's efficacy against S. pyogenes influence your empirical treatment of skin infections in regions with high resistance rates?
I am a little confused by the question. Why would you use TMP/SMX monotherapy for SSTI? During the emergence of CA-MRSA, cephalexin with or without TMP/SMX had the same efficacy rates (Pallin). I agree with Dr. @Dr. First Last; linezolid is a great choice if MRSA is a concern. Cephalexin or cefadrox...
Do you prescribe linezolid to patients who are concomitantly on an SSRI?
Yes, cautiously, especially when LZD is the best or only option. Recent Eur J Clin Pharmacol July 2023 meta-analysis involving 84 publications found an observed rate of < .01%; another study Shi et al., PMID 37301313 found a similar rate (1/1743 persons, 0.06%). Holding an SSRI for a day or two prio...