Nik Rae

Scottish ID Physician. Cocktail enthusiast. Brightly attired. Fan of tweed. New(ish) to Twitter.

[Evidence Rounds @EvidenceRounds]

Oral continues to shine as the new IV for antibiotics

When will it be taboo to "infuse"

@ABsteward @BradSpellberg

[Nik Rae @Nikolas_Rae]

@mubark_wilkins Lads on tour

[Nik Rae @Nikolas_Rae]

Great to combine some infectious diseases and respiratory medicine across Iraq with friend and colleague Dr Mudher Al-Khairalla. Everyone was exceptionally welcoming and it was great to make so many new friends. The Iraqi hospitality (and food) was second to none!

[Brad Spellberg @BradSpellberg]

@IDPharmacist @accpchest A magic 8 ball costs $9.99 on amazon & will give you answers in perpetuity with, I suspect, a similar ROC curve to CRP.
So from that perspective, CRP isn't actually that cheap. It certainly isn't useful. From like, actual data, n'stuff.
https://t.co/OYda9E22pI
CRP #zombietest

[Batman-Echo @echo_batman]

Sacubitril/valsartan compared to equivalent/sub-equivalent dose angiotensin receptor blocker or angiotensin-converting enzyme inhibitor in heart failure with reduced ejection fraction: a meta-analysis of randomized trials | Europ Jour of Clinical Pharma https://t.co/dAyMIBjOVK

[Nik Rae @Nikolas_Rae]

@IdVilchez @wwrighID @BradSpellberg @Cortes_Penfield @dralicehan @ABsteward @DrToddLee @DrEmilyMcD @ParasiteGal @PaulSaxMD I had one of these a few months ago. Failed multiple courses of metro and a course of nitazoxanide. After excluding underlying cause tried metronidazole + albendazole for 7 days which was successful. I found the discussion in this paper helpful.

https://t.co/N4WJNhzyiL

[Nik Rae @Nikolas_Rae]

@ABsteward An absolute unicorn. A “diagnosis” bilateral cellulitis is generally a reflection of lazy medical practice with no actual thought

[Nik Rae @Nikolas_Rae]

Great to see one of our IMTs, Michael Martin, presenting a case of Neuro-Sweet Syndrome at Clinical Grand Round at FIS conference today

[JAMA Network Open @JAMANetworkOpen]

A @Wiki_Guidelines Consensus Statement: For adults with infective endocarditis, oral transitional therapy was at least as effective as IV-only therapy. https://t.co/zkF2POmEGg @DrEmilyMcD @DrToddLee

[Nik Rae @Nikolas_Rae]

@drtimothyli @IdVilchez If no obvious deep seated infection clinically and rapid clinical improvement then 7 days total Tx Benzylpen/Amox. 14 days Rx is only treating clinician anxiety.

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

Wow., it's published! @BradSpellberg et al @CMIJournal
🔥Choosing Patients Over Placebos: Oral Transitional Therapy vs. IV-Only Therapy for Bacteremia and Infective Endocarditis🔥 #IDTwitter
https://t.co/JSYPYnK64E

[Nik Rae @Nikolas_Rae]

Delighted to see our work in @bmj_latest, highlighting key points for generalists in the assessment and initial management of acute infections in people who inject drugs

[The BMJ @bmj_latest]

Acute bacterial infections are common in people who inject drugs, but diagnosis is often delayed as they may hesitate to seek prompt care due to stigma and fear.

How should generalists assess and manage common infections in people who inject drugs?
https://t.co/jf7RCqkHgQ

[Adi @IDdocAdi]

“Good history taking is an important skill”
.
.
Infectious disease docs: say no more

[Nik Rae @Nikolas_Rae]

@Docroddy Glad to have been of service, hope the day got better!😂

[Nik Rae @Nikolas_Rae]

@Abx_doc @anjefus @BradSpellberg @IdVilchez We use pivmecillinam a lot as oral step down in more resistant Gram negative bloodstream infections to complete course when clinically stable and limited other oral options. It seems to work well.

[The Lancet HIV @TheLancetHIV]

New: Risk of hepatitis C reinfection following successful therapy among people living with HIV: a global systematic review, meta-analysis, and meta-regression by @samira_hhr and colleagues https://t.co/khUaXwCeqJ

[Nik Rae @Nikolas_Rae]

@AntibioticLeeds @HCAILeeds @BSACandJAC @UKCPAPIN @ESGAP_ABS Given concerns about increasing MDROs (esp ESBLs) why are empiric aminoglycosides discouraged versus some recommending cephalosporin or aztreonam based regimens?

[Nik Rae @Nikolas_Rae]

@InYourFAECIUM Ouch. Given in vitro does not always = in vivo activity. Sounds ill, if this was mine I would go for broke - tigecycline, imipenem + amikacin with clofazimine + macrolide for starters (Bdq worth looking at), make sure wide debridement and cross my fingers…😬

[Nik Rae @Nikolas_Rae]

@IdVilchez @BradSpellberg @DrToddLee @wfwrighID Have had two patients with lactic acidosis on longer courses, one severe (lactate 26) that was dialysed. We monitor lactate / bicarbonate when on linezolid after that case - no evidence but treats clinician anxiety.