Thread by @edenhelmi

Fairytales or reality, checking some eminence paradigms for treatment of severe infections

#ECCMID2023

Kill fast! These infections must be treated with a "bactericidal" antibiotic
Beatrice Grabein, Germany

Clindamycin is bad for invasive MRSA infection
journals.asm.org/doi/full/10.11…

Tolerance to oxacillin is bad
ncbi.nlm.nih.gov/pmc/articles/P…

We need bactericidal agents in febrile neutropenia

tandfonline.com/doi/abs/10.158…

Conclusion

Bacteriostatic drugs are OK for most infections. However, data for its use in immunosuppressed patients is unclear

Is oral the new IV?
Alex Soriano, Spain

It doesn’t matter the route that we give the antibiotics
PO or per IV
What matters is the concentrations of these drugs in the serum/infection sites

Tmax is delayed with orally given agents vs IV agents

Oral switch may be done earlier in stable patients as the bacterial load is lower in them earlier

Can we switch ever earlier (within 48 hours) in noncritically ill patients?
The answer is yes in terms of drug levels (AUC-driven assessment)

Esp. if the organism's MIC is low (higher PTA)

The presenter believes that in patients with infection trapped in oedematous compartment, the drug levels might be lower due to this:

Into the deep: can tissue penetration of antibiotics make the difference?
Shampa DAS, United Kingdom

Why we use plasma levels as surrogates for tissue concentrations?

Measurement of lung concentrations
BAL for ELF have its own issues:
1) Invasive
2) Methodology is difficult – saline infusion and we need to correct for the value infused during the procedure (BAL) by using urea levels (ELF and plasma)

ELF:plasma levels can be used to calculate the PTA and decide on the dosing regimens for a drug

For STI, microdialysis may be used to measure the drug levels apart from other methods like below:

Microdialysis can also be used to study drug levels in DFI

However, the method has its own issues too like below:

Good things take time: minimum duration of treatment for specific infections
John Turnidge

Why 7, multiple of 7 days, or 5-day duration of antibiotic Rx?
He also touched on other long-standing conventions that we have/tell our patients

However, we should limit the antibiotic use/duration to as short as we can…

And, of course, there is this publication by the esteemed @BradSpellberg

@BradSpellberg Not only shorter antibiotic course might be better, but we can convince the doctors easier as opposed to no antibiotics at all

Where should we put the endpoint if there is a hypothetical study of treatment duration for antibiotic Rx (with 50% being placebo-driven effect)?

This is the most recent summary for the shorter-is-better studies by Davar et al.

academic.oup.com/ofid/article/1…

However, shorter is not better in these conditions:

And this is a lovely new mantra

Shorter is Best!

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