Alasdair Munro

@NIHRresearch Academic Clinical Lecturer | Paediatric Immunology and Infectious Diseases | Clinical trials | Vaccines | Antibiotics | @apsmunro.bsky.social

[Alasdair Munro @apsmunro]

I’ve noticed many comments criticising RCTs of masks or filters come from engineers

These criticisms are often, understandably, caused by misunderstandings about what RCTs are for (engineers do not usually use RCTs)

Here is my attempt to explain

https://t.co/yrhWmsfLne

[Alireza FakhriRavari, PharmD, BCPS, BCIDP, AAHIVP @LordAlirezaF]

🛡️ Why are transplant recipients especially vulnerable to infections as they age?

At #IDWeek2026, Anoma Nellore, MD, explored how immunosenescence + “inflammaging” compound the effects of transplantation.

Key takeaways 🧵👇

[Alasdair Munro @apsmunro]

@EmpiricGame @ABsteward @BradSpellberg @PaulSaxMD @PulmCrit @IDstewardship Osmosing in front of my very eyes

[ID:IOTS podcasting / idiots-pod.bsky.social @IDiots_pod]

Agree, of we’re not all moving to Bluesky or Roon, we might as well ask me on here and intermittently clean our feeds to keep it all the politics/racism

#IDtwitter forever!

[Gus Hamilton @gushamilton]

We have a commentary out on some really interesting findings by colleagues in UCL and Finland on some of the maths behind some of the high profile shingles -> dementia analyses. In brief +
Paper: https://t.co/unZ6RdY79S
Commentary: https://t.co/d4OfTq9m00

[Alasdair Munro @apsmunro]

@IDdocAdi @PaulSaxMD @ppsantyago @ABsteward @BradSpellberg @PulmCrit @IDstewardship I make a special effort to be over-interactive with ID/Med tweets to keep them on my timeline

Otherwise a lot of "viral" slop makes its way on

[Julian Ventres @JulianVentres]

@ABsteward The coolest part to me though was the protocol had patients switch to PO (cephalexin, cefadroxil, or linezolid) at 48-72hr after blood culture clearance. Nice to see early PO protocolized like this, especially with cephalexin and cefadroxil. I'm sure @BradSpellberg will be a fan

[Alasdair Munro @apsmunro]

@EmpiricGame @ABsteward @BradSpellberg @PaulSaxMD @PulmCrit @IDstewardship I think this is true for many, but I’m surprised how many people have eventually reverse osmosed back here…

[Paul Sax @PaulSaxMD]

@ppsantyago @ABsteward @BradSpellberg @PulmCrit @IDstewardship 1. It was very boring.
2. Didn't learn as much.
3. There was zero evidence it was "nicer."
4. Agree that curation of what you say and who you block can make this platform ok.

[Brad Spellberg @BradSpellberg]

Had another discussion with an MD concerned re fosfomycin for pyelo because "it doesn't get into the kidney". The damage guidelines have done medicine is incalculable. Perpetetuators of myth & legend. Forcing patients to get IV when they don't need it. It is time for a reckoning.

[Alasdair Munro @apsmunro]

@EmpiricGame I threw up in my mouth when I saw this

[Alasdair Munro @apsmunro]

@BradSpellberg @PascalMS1 @ABsteward @DrToddLee @PulmCrit @nickmmark @medrants AAP originally advised parents to put their babies to sleep on their tummies

[Brad Spellberg @BradSpellberg]

The 1st of 2 new articles in CID critical of clinical guideline process is out. See
https://t.co/NqHCE8MhSj
It is long past time clinical guidelines incorporate the humility of uncertainty & stop creating standards of care absent of reproducible prospective studies.
@ABsteward

[Alasdair Munro @apsmunro]

@DrCJ_Houldcroft @AliJaneMoore It's bad

[Damian Roland @Damian_Roland]

Underpinning this is a concept that became very apparent during #COVID19

Is the presentation missed, delayed or or late?

https://t.co/XpMWk6cNQq

When undertaking reviews of these cases understanding these subtle differences critical to ensure true learning for the future

[Damian Roland @Damian_Roland]

A tour-de-force in healthcare communication from @apsmunro

The contradiction of a healthcare campaign promoting illness recognition only to see it potentially make the problem worse....

https://t.co/gvRk8TYgHm

[Tim Coats @TJCoats]

Nice explanation from @apsmunro

Sepsis is rare, but devastating. It is a needle in a haystack for emergency care. Campaigns for ‘early awareness’ makes the haystack bigger, meaning that the needles are even more difficult to find.

[Alasdair Munro @apsmunro]

Increasing awareness of sepsis simultaneously increases the number of "missed" diagnoses, whilst also increasing the number of diagnoses made early

This confusing paradox stems from the difficulties of assessing children earlier in the disease process

https://t.co/cEsvNcvSGh

[Alasdair Munro @apsmunro]

There is a massive amount of attention on sepsis and "increasing awareness" among the public

There seems to be little recognition that increasing the amount of early presentations will also, paradoxically, increase the number of "missed" diagnoses

https://t.co/cEsvNcvkQJ

[Joseph Allen @j_g_allen]

the "plague" people in the US should be focused on

[Alasdair Munro @apsmunro]

@surf4children I don’t think it will be an issue beyond the usual UTIs for outpatients, for which fosfo and piv are pretty good

Market is moving in this space too with eg gepotidacin

[Alasdair Munro @apsmunro]

I recently gave a talk at a paediatric OPAT conference which I titled “The death of OPAT”

Given the superiority of oral antibiotics in almost all cases, prolonged courses of IV for children should be considered a failure unless there is an exceptional justification