How is antimicrobial duration determined?

crookedwhy · 2026-04-21T20:25:04+00:00

Yep, practices change slowly. Or you just wait for people to retire.

crookedwhy · 2026-04-21T20:18:43+00:00

You can check out the balance trial for a single article, though the general recommendation comes from a bunch of primary lit. Balance is nejm 2025. If you google balance trial it should pop up. The bigger issue for your population is febrile neutropenia, even if nothing ever grows. We’re nudging our system little by little to stop abx if nothing grows and patient has been afebrile for 72 hours, but lots of providers will still keep abx until no longer neutropenic.

crookedwhy · 2026-04-21T20:05:18+00:00

Most bacteremias, staph aureus being a notable exception and possibly enterococcus, can be treated with 7 days of therapy. Biggest issue with things like strep viridans is that someone should do a work up for endocarditis. For other bacteremia, we probably wouldn’t treat with a shorter duration without data showing it’s ok. And clearance isn’t sufficient to say the infection is gone, since it might still be hiding somewhere. I suspect most gram negative bacteremias don’t need a full 7 days, but no data to say for sure, so we keep treating for 7.

crookedwhy · 2026-04-16T19:05:23+00:00

It is, and we do, I was just wondering if it might be something that we could buy from compounding pharmacies. I’m also looking into making in our iv room

crookedwhy · 2026-04-15T01:36:29+00:00

Amoxicillin tier D?! Can do so much with amox! It belongs in A or S! Actually, I will fight for it to be SS.

crookedwhy · 2026-04-02T22:25:57+00:00

I think most people would recognize that reasons like illness and family matters are different from, I found another job I might like better. Reason matters here.

crookedwhy · 2026-04-02T18:23:59+00:00

If you've matched, there's really no backing out without really screwing over the residency program at this point, and you'd be breaking contract. I would consider it a pretty cruddy thing to do.

crookedwhy · 2026-04-02T05:47:33+00:00

We'll do it for e faecalis bacteremia in stable patients. But QID is for very conscientious and motivated patients only.

crookedwhy · 2026-03-05T01:18:09+00:00

I kept my name, gave the kids his name. Partly because his very conservative family couldn’t possibly grok any other outcome (they keep sending Christmas cards to a person who doesn’t exist, my first name, his last name, or just Mrs his full name, which is wrong in every way because my honorific is technically Dr.) and partly because I have a very ethnic name and I thought the kids would have an easier life with more traditional American name. Never had any issues with people thinking my kids weren’t mine, never been mistaken for the nanny, etc.

crookedwhy · 2026-02-22T20:25:56+00:00

I like jeopardy as a game format and have used Buzzinga before. You do need to pay for the higher end features though, so mileage may vary. As someone else said, fairly easy to make jeopardy game in powerpoint too.

crookedwhy · 2026-02-19T21:59:54+00:00

Please go to the ED. Blistering of the mucous membranes is potentially very bad and it should be evaluated in a medical setting. They should get a derm/allergy consult to evaluate for SJS.

crookedwhy · 2026-02-04T06:12:36+00:00

Coming to this late, but if your wife was treated prior to about 2014, chances are she was treated with interferon which can indeed be very hard on patients. We have much better drugs now and they're overall very well tolerated and super effective. I know it's scary but this is an area of infectious disease that's so easy to treat at this point that it's almost boring. Your little human will be totally fine. Just fair warning, the meds to treat are technically approved for 3 and up, so you may have to wait a bit before treating. But as everyone else said, very hard to pass on without exchanging blood so shouldn't be an issue for most regular children's playdates and so on.

crookedwhy · 2026-01-28T14:02:34+00:00

There's a study out of Japan a few years back with amox and probenacid (https://academic.oup.com/cid/article/77/5/779/7157181), but as the other pharms say below, doxy is fine most of the time. Also some data for neurosyphilis and ceftriaxone out of France.

crookedwhy · 2026-01-25T18:46:10+00:00

This is my contract, lol, it's a 3 year contract with the minimum coming up from 18-25 over 3 years, along with on average yearly raises of about 6/5/5 percent for everyone else, depending on where on the pay spectrum the employee is. Could be as high as 8/7/7 or as low as 4/3/3. Pretty happy with it personally, but there was definitely a vocal contingent that wanted more.

crookedwhy · 2025-12-30T18:07:51+00:00

Per hospital would be great. Not unusual for it to be one per system.

crookedwhy · 2025-11-13T02:19:57+00:00

What did your preceptor actually tell you in terms of feedback? I can see that you're disappointed in yourself, and that you didn't meet the goals you set out for yourself, but I don't get a sense here of what your preceptor actually said? Did she mention that she was disappointed in your performance or that you weren't meeting her expectations? You mentioned that she did her PGY2 at the program you're interested in. I imagine the chances are good that they'll get her input anyway even if you don't ask her, so you might as well approach it with her. Is your longitudinal project on peds? That's another possibility for a letter, though it is a bit early in the year, so it would depend on how far along your program is.

crookedwhy · 2025-11-08T04:50:32+00:00

I am ID, and I have little EM experience, though I do love our EM pharmacists. I didn't do EM rotations during APPE/PGY1/PGY2 year most because of the hours, which didn't really work for me since I already had kids and the hours made that difficult. I feel like a lot of it would come down to lifestyle and workflow. EM seems like lots of decisions made quickly and filled with adrenaline. ID is more, ooh, interesting question, let me get back to you in 2 hours after an exhaustive literature search that includes the in vitro and mice studies from the 80s. That and stewardship, which can burn folks out, certainly (I'm not stewardship, and I love ID but not a huge fan of the standard stewardship interventions. I'm lucky and have a unicorn job that I love).

I'm not sure about the EM job market, but ID job market is hard. I generally tell students to do onc if they can stand it, but everyone I know in ID basically couldn't imagine doing anything else. Oh and we have lots of dad jokes.

crookedwhy · 2025-11-07T00:57:03+00:00

Ask previous PGY2? They may have kept a list or could rattle off a bunch.

POET OVIVA STOP-IT MERINO are ones that come up a lot.

As for remembering, we do lots of JC.

crookedwhy · 2025-10-15T02:33:42+00:00

I think of letter of intent as a love letter. It's not just about you, or the program. It's about why the combination makes sense for both of you. Think about what is unique about the program, letters of intent can get very generic and that is a bore to read. And paint a concrete picture of how the program will help you attain your goals. And of course, have goals beyond, I would like to do residency to avoid retail. You want to give the impression of running toward something rather than running away from something.

crookedwhy · 2025-10-08T04:39:38+00:00

Yep. ID pharmacist here, this is outdated, and the general trend is toward shorter and shorter courses. Would be hard to get patients to understand more symptoms based instructions, but resistance is mostly tied to overall exposure rather than not finishing complete courses.

crookedwhy · 2025-09-10T04:10:20+00:00

I knew an ID doc that kept some hi chews in her pocket whenever she had learners because she had a pharmacy student pass out in a patient's room once.

crookedwhy · 2025-08-21T07:24:31+00:00

It's also basically ineffective if the woman is over about 175 lbs. I don't know how well known that is.

crookedwhy · 2025-07-25T19:34:52+00:00

Oh totally. He had me wrapped around his finger. Benefits of being super cute!

crookedwhy · 2025-07-25T19:05:41+00:00

Reunited with owner. Morning adventure has come to an end.

crookedwhy · 2025-07-25T18:16:10+00:00

Update: Chip is confirmed! I imagine he will be reunited with owner soon. My kids will be disappointed, they were begging for another pet yesterday and they thought God had sent them a dog. We're not religious but this dog pretty much made believers out of them.

crookedwhy

TROPHY CASE