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Akshatha R Profile picture
@IDdocAkshatha
Jun 8, 2023 • 6 tweets • 6 min read • Read on X
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#IDSA AMR Updates 2023
#IDtwitter
#Medtwitter
Updates in ESBL E
To avoid piptaz in non UTI
To avoid Cefepime
No role of Cephamycins
No role of Ceftalazone - Tazobactam
@CidsIndia
@idcon2022 @id_cure
@IDstewardship ImageImageImageImage
Updates in AmpC
Explained well about How to choose Antibiotics in AmpC - ImageImageImage
Updates in CRE -
Explicitly mentions TOC for NDM, OXA, KPC & while awaiting reports.
No role of Tetracycline derivatives in UTI/ BSI ImageImageImageImage
Updates in Pseudo
TOC for MDR Pseudo
TOC for MBL - No added benefit of Ceftazidime -avibactam+Aztreonam vs Aztreonam alone
Combination therapy in DTR Pseudo-Don't use Polymxin+Aminoglycosides -use Newer BL-BLI+Tobramycin if tobra is S, if R use Newer BL-BLI+ Polymyxin ImageImage
Updates in CRAB
CRAB therapy -Sulbactam + Mino>Tige , or Sulbactam + Polymyxin B, Mero + Poly B not to be used
If using Ampicillin - Sulbactam - panel suggest *against* the use of Meropenem in the combination ImageImage
Stenotrophomonas updates
Combination only - no role of single agent
Ceftazidime -avibactam + Aztreonam if clinical instability, intolerance Image

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More from @IDdocAkshatha

Akshatha R Profile picture
Jun 18
#IDtwitter
#1minID
#Day18
#IDdocAkshatha
How many of you treat C.diff?
What is the DOC?
How many of u use T. Metronidazole?

1/n
#IDtwitter
#1minID
#Day18
#IDdocAkshatha
If possible, stop the inciting antibiotic
In general, avoid antiperistaltic during acute phase
Mild - Moderate dis
T.Fidaxomicin 200 mg po bid x 10 days
Or
T.Vancomycin 125 mg po qid x 10 days
Note : It is oral Vanco NOT IV

2/n
Fulminant (Severe) disease
T. Vanco 500 mg q6h po or via nasogastric tube +/- Metronidazole 500 mg IV q8h

For patients with ileus, administer Vancomycin 500 mg in 100 mL normal saline per rectum as a retention enema q6h

So what to do if Oral Vanco is not available?

3/n
Read 4 tweets
Akshatha R Profile picture
Jun 10
#IDtwitter
#1minID
#Day17
#IDdocAkshatha

WHO Malaria Chemoprophylaxis

IPTp-Intermitten Preventive treatment in pregnancy
All pregnant women
Sulphadiazone - pyrimethanamine in 2nd trimester (not before Week 13)
Atleast 3 doses - 1 month apart

1/n
PMC-Perennial malaria chemoprevention
In Infants & young child in subsaharan Africa (upto 24 mon) in Mod-high Perennial malaria (incidence of >10% P.falciparum or API >250/1000)
SP given with vaccine

2/n
#IDtwitter
#1minID
#Day17
SMC-Seasonal Malaria Chemoprevention
Children <5y at high risk of severe Malaria in areas with seasonal Malaria
Monthly SP+Amodiaquine

PDMC-Post-discharge Malaria chemoprevention
For child in mod-high Malaria foll admission with severe anaemia

3/n
Read 5 tweets
Akshatha R Profile picture
Nov 28, 2022
#IDtwitter
#MedTwitter
#MedEd
#Tweetorial
#LearnwithDrAksh
What do you use for treatment for endocarditis caused by HLAR +ve Enterococcus faecalis?
🧵 Tomorrow
#Tweetorial
#IDTwitter
#MedTwitter
#MedEd
Lets talk about #Enterococcus #bacteremia 🧵
2 important species - E.faecalis, E faecium
E.faecium is generally more resistant, but lower risk of endocarditis
E.faecalis, usually S to Ampicillin, but IR to Quinopristin-Dalfopristin
1/6
Also, note- Enterococcus is IR to Cephalosporins, Aminoglycosides
Bacteremia source - Indwelling catheter, GI, Urinary tract
DOC for bacteremia - Ampicillin/Penicillin if S
If, Ampi R - Vanco/Teico
Combination therapy in case of suspicion of endocarditis or septic shock
2/6
Read 8 tweets
Akshatha R Profile picture
Nov 27, 2022
#IDtwitter
#MedEd
#MedTwitter
How many of you do Skin test before administration of antibiotics?
Most Indian hospitals test for antibiotic sensitivity, without knowing the basis of testing
Lets learn a lil about Antibiotic allergy testing 🧵
#MedTwitter
#IDtwitter
#MedEd
#tweetorial
#TweetOfTheDay
#LearnwithDrAksh
#
1/12
1. Skin test - Is done to identify hypersensitivity - which can be IgE or Non IgE mediated. Hence, sensitivity can be seen within 1h (IgE mediated) or >1h (Non-IgE mediated)
So, no guarantee that a patient with skin test negative will not have hypersensitivity later
Read 14 tweets

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