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@unknown
Apr 16 • 4 tweets • 2 min read Twitter logo Read on Twitter
#ECCMID2023 1/3. Alex Soriano: PO the new IV? Need to consider oral bioavailability, pathogen MICs, delays to Cmax, inter-individual variability in BA etc ImageImage
2/3 Numerous RCTs now demonstrate short course therapy is adequate for most syndromes; RCT of oral switch in severe CAP is safe and reduced LoS pubmed.ncbi.nlm.nih.gov/17090560/ Image
3/3 Early oral switch in non-critically ill febrile patients: The acute phase of infection does not influence the exposure or PTA for PO amoxicillin or cipro
pubmed.ncbi.nlm.nih.gov/36433818/
Another important point - effect of oedema in soft tissue infection, increasing the volume of distribution which may compromise lower oral dosing Image

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Apr 16
#ECCMID2023 Tom Harrison, keynote masterclass in the management in cryptococcal meningitis: how a wood-rot fungus leads to such serious disease; major burden of disease, >100,000 deaths /year, 19% of AIDS related death, >60% mortality in the past Image
No dec. in cases in Sub-Saharan Africa outside SA, despite ART; IDSA standard of 2w AmpB + 5-FC based on studies from 1990s e.g. nejm.org/doi/full/10.10… but AmpB is hard to find in many countries, needs IV, hard to administer and monitor - Flucon monotherapy not as effective Image
Fluconazole just has much less early fungicidal activity vs AmpB - not helped much with higher doses, seem 1200mg or if adding 5-FC does approach efficacy of AmpB and possible improved survival - helps prevents flucon-R emergence via heteroresistance (@DrNeilStone !) ImageImage
Read 5 tweets
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Apr 15
Thomas Louie: so what is ADS024 I hear you say?? Let's see....
New treatment for C. difficile - novel oral single strain LBP (Bacillus velezensis) ; anti-inflammatory and anti-toxin activity nature.com/articles/s4159…
Phase 1b double blind multi centre RCT - safety and tolerability for up to 28 days, F/U for 6 months; patients with recurrent CDI, small numbers given early phase trial (n=27 vs 9); recurrence frequency was similar in both arms, but well tolerated
Read 4 tweets
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Apr 15
Trish Peel from 🇦🇺🐨🦘 : ASAP trial of Abx prophylaxis for prosthetic joint surgery. #ECCMID2023 pubmed.ncbi.nlm.nih.gov/31685516/
Inc. rates of MRSA and MR-S. epi , need to add glycopeptide to prophylaxis? Needed an RCT. Double blinded superiority RCT undergoing joint replacement / revision surgery. Imbedded staphylococcal carriage study (nasal/skin swabs); primary outcome SSI up to 90d
Sample size 4320 pts based on 5% vs 3% risk (i.e 2% reduction with intervention); COVID disrupted a bit; slightly high MRSA carriage in placebo; knee surgery infection 3.7% vs 5.7% in placebo vs. vanco (RR 1.52; 95% confidence interval 1.04 to 2.23; p value 0.031)
Read 4 tweets
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Apr 15
Sara Grillo (Barcelona) SAFO trial: S. aureus bacteraemia, standard of care is mono therapy with beta-lactam in MSSA; adding fosfomycin? in vitro synergy and anti-biofilm effects; clot + fosfo vs clot alone ; 19 hospitals, superiority trial, randomised within 72h
combo given for first 7 days; TOC at 12 weeks; sample 183 for 86 vs 74% treatment success at day 7 with endpoint composite of alive + stable / improved SOFA, no fever + neg BCs for MSSA; 215 randomised; ITT included 104 vs 110
Similar baseline characteristics; Image
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