In this episode of Breakpoints’ Dosing Consult series, Drs. Chuck Peloquin and Gerry Davies join Dr. Megan Klatt to discuss rifampin dosing for mycobacterial infections. Hear from the experts on if higher doses are really better, toxicity thresholds, and the role of alternative rifamycins for patients with MTB and NTMs.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp

References:

1. Efficacy and Safety of High-Dose Rifampin in Pulmonary Tuberculosis. A Randomized Controlled Trial. Am J Respir Crit Care Med. 2018 Sep 1;198(5):657-666. doi: 10.1164/rccm.201712-2524OC.
2. Rifampin vs. rifapentine: what is the preferred rifamycin for tuberculosis? Expert Rev Clin Pharmacol. 2017 Oct;10(10):1027-1036. doi: 10.1080/17512433.2017.1366311.
3. Rifabutin for treating pulmonary tuberculosis. Cochrane Database Syst Rev. 2007 Oct; 2007(4): CD005159. doi: 10.1002/14651858.CD005159.pub2.
4. Implementation of Bedaquiline, Pretomanid, and Linezolid in the United States: Experience Using a Novel All-Oral Treatment Regimen for Treatment of Rifampin-Resistant or Rifampin-Intolerant Tuberculosis Disease. Clin Infect Dis. 2023 Oct 5;77(7):1053-1062. doi: 10.1093/cid/ciad312.

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Drs. Jim Rhodes and Molly Steed join host Jeannette Bouchard to discuss all things related to optimal dosing of daptomycin. This podcast episode provides insight on why dosing matters with this antibiotic, especially with certain organisms (looking at you, E. faecium), why weight matters with dosing, and what that pesky CPK means.

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ 

References:

1. Fixed-dose daptomycin in Staphylococcus aureus: doi 10.1002/phar.4602
2. High dose daptomycin for VRE: doi 10.1093/cid/ciw815

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In this episode, Drs. Erica Stohs, Ryan Stevens, and Jame McCrae join Dr. Megan Klatt to discuss antimicrobial stewardship practices at transitions of care and in the outpatient setting. Hear from the experts on how to establish programs in this space, best practices for data/reporting, and other tips for stewardship intervention.

Follow us on Instagram! @breakpointspodcast_sidp

References:

1. Pharmacist-Driven Transitions of Care Practice Model for Prescribing Oral Antimicrobials at Hospital Discharge. 10.1001/jamanetworkopen.2022.11331
2. From concept to reality: Building an ambulatory antimicrobial stewardship program. 10.1002/jac5.1528
3. Cracking the code(s): Optimization of encounter-level diagnosis coding to inform outpatient antimicrobial stewardship data modeling. 10.1017/ice.2023.296
4. Antibiotic Prescribing Variability in a Large Urgent Care Network: A New Target for Outpatient Stewardship. 10.1093/cid/ciz910
5. DART communication for respiratory illness treatment resources: Dialogue Around Respiratory Illness Treatment (DART) – iMTR (uwimtr.org)

Join Prof Jason Roberts and Dr. Erin McCreary for this episode dedicated to discussing the results of the BLING III trial, which explored the use of continuous versus intermittent infusion of a beta-lactam antibiotic in critically ill patients.

Reference: Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. 10.1001/jama.2024.9779

Drs. Jeffrey Pearson and Jason Pogue join Dr. Jeannette Bouchard as they take on all things tetracyclines. Starting with tetracycline, they walk through differences between each generation and drug in this class, from dosing all the way to pertinent resistance mechanisms. You will not want to miss out on this one! This podcast was supported by an unrestricted grant from Paratek Pharmaceuticals Inc.

References:

• Omadacycline for Mycobacterium abscessus full case series data set: 10.1128/aac.00824-23
• Long term safety of omadacycline in Mycobacterium abscessus: 10.1093/ofid/ofad335
• USCAST Acinetobacter baumannii Recommendations for Susceptibility Test Interpretive Criteria: https://www.uscast.org/uploads/1/1/9/0/119044870/uscast_alepak_acbc_stic_08feb23.pdf

Drs. Yohei Doi and Emily Heil join Dr. Erin McCreary to dive into one of the most requested topics from our listeners and something that is consistently confusing in clinical practice: Acinetobacter baumannii! Hear from experts on their experience with treating this tricky organism and their thoughts on best approaches when you are presented with CRAB. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ 

References:

1. SNAP doi:10.1128/mbio.02759-2
2. ATTACK doi:10.1016/S1473-3099(23)00184-6
3. CRAB among COVID patients: doi:10.1093/jac/dkad042

Drs. Chris Crnich, Angela Huttner, and Jeannette Bouchard join Dr. Erin McCreary to discuss all things uncomplicated UTIs! Gain insight into where our new guidelines may be headed and pearls from experts in a variety of clinical settings, including a clinic specifically devoted to UTIs! Funding for this podcast was supported by an independent medical education grant from GSK.

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

References:

• Proposing the "Continuum of UTI" doi: 10.1097/JU.0000000000003874
• UTIs exciting new frontier doi: 10.1016/j.cmi.2022.07.016
• Fosfo vs Nitro doi: 10.1001/jama.2018.3627

In this special LIVE podcast episode, Drs. Emily Heil (@emilyheil) and Mandee Noval (@MandeeNoval) present the latest and greatest in ID literature from MAD-ID 2024 (@MAD_ID_ASP) in Orlando, FL. They cover everything from ECCMID late breakers to stewardship to the best things to come out of a good old shortage! You won’t want to miss this one!

Google Drive to Slides from Live Session: https://drive.google.com/file/d/1L4zq0ZC5LW9cCySE0AiJL7m8qDxS9MGM/view?usp=sharing

Submit your 100th Episode videos at: [email protected]

Check out more information on ID Pharmacists Day on May 22nd, 2024 at SIDP.org/IDPharmacistsDay

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

Episode Notes

The Society of Infectious Diseases Pharmacists is excited to invite you to the first ever meeting (via Breakpoints) of The Tortured Stewards & Surgeons Department. Today’s agenda items: optimal management of perioperative antibiotics and prevention of surgical site infections.

Drs. Trisha Peel (@DrTrishaPeel), Michael Calderwood (@CalderwoodMD) and Patch Dellinger join Dr. Jillian Hayes (@thejillianhayes) to discuss some of the controversies we encounter while managing antibiotics in the perioperative space. Does anyone really need post-op antimicrobial prophylaxis longer than 24 hours? Where should vancomycin be fitting into surgical prophylaxis regimens? Can we truly give pre-operative cefazolin to patients with a penicillin allergy? Tune in for the answers to these questions and more!

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp

If you’d like more information about the CALIPSO trial, please visit this link: https://www.anzca.edu.au/profiles/ctn-trials/underway/calipso

Bibliography

1. SSI Infection Prevention Review: https://jamanetwork.com/journals/jama/article-abstract/2800424#:~:text=Six%20are%20supported%20by%20randomized,use%20a%20chlorhexidine%20gluconate%2Dalcoho
2. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-surgical-site-infections-in-acutecare-hospitals-2022-update/2F824B9ADD6066B29F89C8A2A127A9D
3. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update: https://journals.lww.com/journalacs/citation/2017/01000/american_college_of_surgeons_and_surgical.8.aspx 
4. 2017 CDC Guidelines: https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725 
5. 2018 WHO Guidelines: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
6. ASHP Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery: https://www.ashp.org/surgical-guidelines 
7. Surgeons as Stewards: https://journals.lww.com/journalacs/citation/2020/12000/perioperative_antibiotic_prophylaxis__surgeons_as.23.aspx 
8. Li et al, Arthroplasty 2022: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
9. Dutch Arthroplasty Register Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023957/ 
10. de Jonge Meta-Analysis on duration and incidence of SSI: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/abstract 
11. Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance: https://www.ahajournals.org/doi/10.1161/01.cir.101.25.2916?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
12. RCT - Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: https://jamanetwork.com/journals/jama/article-abstract/2810510 
13. NYU Langone Study - Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution: https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=91dee3e1445adb80d533f2c210816a3285254e3a 
14. Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty: https://www.nejm.org/doi/full/10.1056/NEJMoa2301401
15. What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744972/ 
16. Drug allergy: a 2022 practice parameter update: https://www.jacionline.org/article/S0091-6749(22)01186-1/fulltext 
17. Perioperative use of cefazolin without preliminary skin testing in patients with reported penicillin allergy: https://www.surgjournal.com/article/S0039-6060(18)30307-6/abstract#%20 
18. Timing of Surgical Prophylaxis RCT: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30176-7/abstract 
19. Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815528

In this episode, Drs. Helen Boucher (@hboucher3), Ramy Elshaboury, and Mike Dudley (@MikeMNDudley) join host, Megan Klatt (@MeganKlatt3), to discuss barriers to antimicrobial drug development, potential incentives and legislation to promote market growth, and what we can do to ensure the antimicrobial pipeline doesn’t run dry.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp

References

1. An analysis of antibacterial drug development trends in the United States, 1980-2019: Dheman N, et al. Clin Infect Dis. 2021 Dec 6;73(11):e4444-e4450. doi:10.1093/cid/ciaa859. PMID: 32584952.
2. Antibacterial R&D at a crossroads: we’ve pushed as hard as we can…now we need to start pulling!: Rex JH, Outterson K. Clin Infect Dis. 2021 Dec 6;73(11):e4451-4453. doi:10.1093/cid/ciaa852. PMID: 32584949.
3. No Patient Left Behind (website): https://www.nopatientleftbehind.org/ (many useful explainers of how the investment, innovation cycle, and drug pricing work)
4. ISPOR special task force report on defining elements of value in health care – a health economics approach: Lakdawalla DN, et al. Value Health. 2018 2018 Feb;21(2):131-139. doi: 10.1016/j.jval.2017.12.007. PMID: 29477390.
5. Generalized cost-effectiveness analysis to assess treatment value in hepatitis C: Chou JW, et al. Am J Manag Care. 2023 Dec;29(12):696-703. doi: 10.37765/ajmc.2023.89468. PMID: 38170486.