Bug Pharmacist 💊🧫 Tim Gauthier

I ❤️ bugs & drugs. Here to teach & learn about antibiotics. Opinions mine. SUBSCRIBE:

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

💊 Cephalexin for severe infections: how high is high enough?

📖 OFID | 2026 | Haynes et al.

🔬 What they did
Pooled PK data from 71 patients (9 days–29 years) to model cephalexin exposure and target attainment across ages, pathogens, MICs & dosing regimens.

📌 Key findings

🦠 MSSA
• 25 mg/kg/dose (max 1,000 mg) q8h → ≥98% PTA for 35% fT>MIC at MIC 4 mg/L
• MIC 8 mg/L → q6h needed

🦠 Enterobacterales
• Standard dosing was insufficient for 60% fT>MIC
• 37.5–50 mg/kg/dose (max 1,500 mg) q6h → >90% CFR for 40–50% fT>MIC when cefazolin MIC ≤2 mg/L

👶 PK varied with age, with increasing clearance with maturation and slower absorption in neonates.

#idxposts

https://t.co/Dwcd8Z3tsA

[Snacks, PharmD, MPH @zacroBID]

When will the dinosaurs change? 🦕 More GRADE nonsense, no reference to the UTI WikiGuideline, no pharmacotherapy experts (pharmacists) in the guideline panel. Do better @AmerAcadPeds

https://t.co/TZm7tz3TVV

[SIDP @SIDPharm]

You asked, and we answered! PDF formats will be available on our website for future infographics. Check out the PDF version of our latest infographic for Episode #140 – Beta-lactamase Inhibitors “Scientifically elegant, just complex.” More infographics coming your way soon!

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

Finally it's published!
🆕🔥🟢Systematic Review and Bayesian Meta-Analysis @DrToddLee
What is the association of cefepime with all-cause mortality compared with other β-lactam antibiotics?
This systematic review and bayesian meta-analysis found that cefepime was associated with higher odds of all-cause mortality compared with other β-lactams Meta-analysis of published peer-reviewed RCTs (73 trials, 15 411 patients) showed that cefepime was associated with a 98.6% posterior probability of higher mortality compared with other β-lactams (OR, 1.17; 95% credible interval, 1.02-1.34). Posterior distributions generally favored higher odds of mortality across all comparator β-lactams, across all clinical indications, and with doses of 2 g or more every 12 hours. #idxposts https://t.co/RNML77btb6

[Clinical Infectious Diseases @CIDJournal]

Cefepime versus piperacillin-tazobactam for the treatment of Pseudomonas aeruginosa pneumonia

🔁 Repost
✍️ @raneempallotta
🔗 https://t.co/jNdwWlkGXL

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

A wise friend once said
"Cellulitis is strep. We never isolate it." @BradSpellberg
🆕✨🔴Non-Purulent Cellulitis—An Updated Review #idxposts
https://t.co/1lwDtAv70l

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

🆕✨PRACTICE POINTER @bmj_latest
Diagnosis and management of lower limb cellulitis #idxposts
https://t.co/2WCFAHiEVY

[S.Enf.Infecciosas HRUM @infeccHRUmalaga]

En @CIDJournal NEUMONÍA #Paeruginosa🩻PPZ/TZB (117)🆚 CEFEPIME (87)
Pacientes SIMILARES características
MAYOR MORTALIDAD en PPZ/TZB (23%vs11.5%; p=0.04)📈☠️
Probablemente por MEJOR penetracion pulmonar💉👉🏻🫁de CEF q PPZ/TZB muy importante en CMI “límites”
https://t.co/1NlkifJzFl

[Bug Pharmacist 💊🧫 Tim Gauthier @IDstewardship]

🔥 📄 #WhatsHotWedneaday here is what people in the world of ID are talking about for the 9/9/2026 report out. All links in the Teacher’s Corner of Learn Antibiotics dot com. #MedEd #PharmEd #LearnAntibiotics #SaveABX

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

🔥🔥Back online🔥🔥
IDSA/ESCMID 2026 Guidelines on Staphylococcus aureus Bacteremia: Risk Stratification, Diagnostic Evaluation, and Management of Adults and Children Part-1
#IDXposts
https://t.co/X1kOKsrVfg

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

🔥Just published 🔥
Infective Endocarditis: Diagnosis, Antibiotic Therapy, and Management: A Scientific Statement From the American Heart Association #idxposts #IEWiki
https://t.co/0yXAfs4X6X
Thanks @Inox94

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

This is an excellent infographic ,a summary of the beta-lactamase inhibitors reviewed in the new @SIDPharm #Breakpoints episode "Beta-lactamase inhibitors: Scientifically elegant, just complex."
Link to podcast: EnJoy! https://t.co/b3bkwBRDkm
#idxposts #bookmark

[Bug Pharmacist 💊🧫 Tim Gauthier @IDstewardship]

👀 People are taking advantage of this Labor Day discount. Are you?

😊Tell your learners and peers. 😈Don’t let your enemies find out!

https://t.co/GlUtvHp0Jm

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

It's a small study ( n: 204) but published in CID!
In the same direction that anaerobic antibiotics causes higher mortality
The debate continues!
🆕💥🟢 Single-center retrospective cohort study
Cefepime vs piperacillin-tazobactam for the treatment of Pseudomonas aeruginosa pneumonia
All-cause mortality occurred more frequently in patients who received piperacillin-tazobactam (23.1%) compared with those receiving cefepime (11.5%; p = 0.04, OW odds ratio 2.38, 95% CI 1.05–5.42). No statistically significant differences in DOOR, clinical success, or resistance were observed #idxposts @DrToddLee https://t.co/PKMKKqqhZc

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

🆕💥🔴Multicentre cohort(SAVE study)
Daptomycin or linezolid Vs vancomycin in the treatment of vancomycin-susceptible Enterococcus faecium bloodstream infections
Linezolid or daptomycin was not independently associated with treatment failure #idxposts
https://t.co/6KIgipc9Qw

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

🆕🔥🔥POET II RCT NEJM
Among patients with infective endocarditis on the left side of the heart, the use of a response-tailored antibiotic strategy* resulted in a longer time alive without antibiotic therapy than standard-duration therapy and met the criterion for noninferiority with respect to safety but was associated with a higher incidence of relapse of bacteremia or IE #IDXposts
https://t.co/64HYjBryLU

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

🆕💥🟢FENDER RCT Protocol
An open-label, multicentre phase III clinical trial
Fecal microbiota transplantation versus vancomycin or fidaxomicin in Clostridioides difficile infection first episode and first recurrence #idxposts
https://t.co/CUksKmWGjp

[Brad Spellberg @BradSpellberg]

Congratulations @Wiki_Guidelines on publication of the latest guideline, on management of complications of persons who inject drugs! Great job team! Let's spread widely! https://t.co/HnsNAc3Yth
@ABsteward

[Bug Pharmacist 💊🧫 Tim Gauthier @IDstewardship]

🔥 📄
Quick snapshot of recent ID articles. Find links here: https://t.co/0uCU6vH2Of #IDxPosts

[ACCP INFD PRN @accpinfdprn]

More daptomycin and linezolid use—but no resistance penalty? 👀

After prescribing restrictions were eased, use increased. Yet across 19,160 isolates, investigators found no clinically relevant rise in resistance.

https://t.co/F76Li8fUMB

#IDxPosts #AntimicrobialStewardship