Comments for HIV and ID Observations

Comment on PrEP Works in Injection Drug Users, CDC Offers “Guidance” by Paul Sax

Paul Sax — Wed, 19 Jun 2013 10:15:26 +0000

Jamie,
Agree the NNT would be high. My sense is that the impact on the IDU population in the USA would be low for three major reasons: 1) Many IDUs are not at high risk, as defined by the CDC guidance; 2) Adherence is often low in this population; 3) The overall incidence of HIV among IDUs here has been declining for years.
Paul

Comment on PrEP Works in Injection Drug Users, CDC Offers “Guidance” by Jamie K.

Jamie K. — Tue, 18 Jun 2013 14:29:18 +0000

Dr. Sax,

Although this study was able to show a positive impact in such a high risk population, I wonder if cost should be considered as well from a resource perspective. Can you comment on the financial burden to society with such a high NNT in this study and current cost of Truvada at $1200-1400/month. Do you think the U.S. population of IVDU would see the same impact? Would other interventions like needle exchange programs, education, and increased testing be more cost effective, especially since these measures seemed effective in this study.

Thank you for sharing such great information on your blog.
Jamie K.

Comment on ID Learning Unit — Aminoglycosides by Paul Sax

Paul Sax — Thu, 13 Jun 2013 13:07:07 +0000

Up to date recommends once daily dosing of aminoglycosides for CF and references guidelines by the CF foundation

Stu,
You are absolutely right — but the dosing is very different. Have edited post to clarify.
Paul

Comment on ID Learning Unit — Aminoglycosides by Paul Sax

Paul Sax — Thu, 13 Jun 2013 12:39:42 +0000

Should we favor gentamicin or ertapenem for OPAT in this case? Many of my colleagues will give the carbapenem. I like the aminoglycoside for cost and spectrum issues. Any thoughts?

Aside from the fact that I’ve found a bunch of these ESBLs to be resistant to gentamicin, so need to use amikacin, I agree with you that the AG option is one that should be considered more often.

Paul

Comment on ID Learning Unit — Aminoglycosides by Howard Heller

Howard Heller — Thu, 13 Jun 2013 11:57:16 +0000

The pearl to teach in order to get people to spell them correctly: those derived from Streptomyces end in -ycin (e.g. tobramycin, streptomycin)and those derived from Micromonospora end in -icin (e.g. gentamicin, netilmicin). It can have relevance for cross resistance patterns. So what’s up with amikacin?? It’s the only one that is synthetic and not found in nature.
It’s one of the trivia I cover on Day 1 of every rotation. 24 years of former fellows and residents and students spell gentamicin correctly.

Comment on ID Learning Unit — Aminoglycosides by Stu

Stu — Thu, 13 Jun 2013 08:31:06 +0000

Up to date recommends once daily dosing of aminoglycosides for CF and references guidelines by the CF foundation

Comment on ID Learning Unit — Aminoglycosides by Marco

Marco — Thu, 13 Jun 2013 02:11:50 +0000

Thanks for the instructive blog on AG. Clearly, toxicity issues have relegated aminoglycosides to third line or fourth line in many indications. One situation I find difficult is the healthy and young (<50 yrs) woman with acute pyelonephritis due to an ESBL strain susceptible only to carbapenems and aminoglycosides. Should we favor gentamicin or ertapenem for OPAT in this case? Many of my colleagues will give the carbapenem. I like the aminoglycoside for cost and spectrum issues. Any thoughts?

Comment on ID Learning Unit — Aminoglycosides by AP

AP — Wed, 12 Jun 2013 21:12:32 +0000

Question from an ignoramus — but one not young enough, sadly, to have never used AGs routinely. I love your blogs. What about empiric AG for neutropenic febrile patients with sepsis and suspected or possible GNRs to not rely on beta-lactam coverage alone until cultures return? I still do that every once in a while. Is it crazy?

Comment on ID Learning Unit — Aminoglycosides by Paul Jawanda

Paul Jawanda — Wed, 12 Jun 2013 15:18:01 +0000

And a burning question: why is streptomycin more commonly administered IM rather than IV? Could never recall the toxicity risk and issues that call for IM administration to be the preferred route.

Comment on ID Learning Unit — Aminoglycosides by Paul Jawanda

Paul Jawanda — Wed, 12 Jun 2013 15:13:20 +0000

I think useful to also note the niche of amikacin for treating mycobacterial infections. In practice, seems that we use amikacin more than streptomycin for MAC and M.abscessus. Nebulized amikacin is used not uncommonly in certain pulmonary NTM patients. One also questions when dosing IV amikacin in these pts, dose MTW, M Th, M-F?? Seems that for the non-daily IV amikacin treatment in these patients, it is part science and part personal experience and opinion as how to dose . . .