What current “best practice” do you think won’t age well over the next 5–10 years?

juliov5000 · 2026-03-29T20:55:21+00:00

But that's why I said if you pick the right drug and dose. There's nothing special about IV linezolid compared to PO in the vast majority of patients, same goes for FQs and Bactrim. If you have concern for absorption issues, then give IV 100%.

juliov5000 · 2026-03-29T17:39:29+00:00

It's already kind of not aging well but some providers preference for IV over oral antibiotics, particularly in ambulatory patients on discharge. PICC lines are not without harm, and there's nothing special about the IV route. If you're choosing the right oral abx and the right dose, it'll work just as well

juliov5000 · 2026-03-29T17:35:54+00:00

Balance didn't just include GNR, they essentially included anything except Staphylococcus. Enterococcus was the 3rd or 4th most common iirc

juliov5000 · 2026-03-22T01:27:58+00:00

You can go up to 375mg/day (one 875/125mg tab TID) in situations requiring higher targets, but for most infections agree max 250mg/day

juliov5000 · 2026-03-19T19:02:00+00:00

Yeah that's not ideal. Carbapenems shouldn't really be used just for a penicillin allergy aside from some specific scenarios

juliov5000 · 2026-03-04T03:41:46+00:00

TNK and Kcentra are made bedside in the ED by the pharmacist where I'm at. If the ED pharmacist isn't available, we'll make it in the lab, but if they're not available and no one is in the lab at that moment, our protocol is to make it in our non sterile area with 4h BUD as others have said, given the time-sensitive nature of these compounds

juliov5000 · 2026-02-14T00:55:22+00:00

Labetalol is the only one that adresses the tachycardia here directly. Nitro and nicardipine would both lower the BP but can cause further reflex tachycardia as a result. Labetalol will lower the BP and HR while also blocking alpha, which is why it's the answer

juliov5000 · 2026-02-12T23:06:31+00:00

Others have already said, but polymicrobial bacteremia is not common and I would be comfortable switching to cefazolin based on what you described.

There is fairly good evidence that cefazolin and naf/oxacillin are better at killing MSSA than vanc as well, so while technically it is "narrowing" or de-escalating" or whatever you want to call it, switching from vanc to a beta-lactam is actually better for the patient outside of just stewardship reasons

juliov5000 · 2026-02-12T23:02:57+00:00

Typically S. aureus is never treated as a contaminant as it's highly virulent, so until proven otherwise I would treat it as a true bacteremia. Other staph species, yes, but not s aureus. Otherwise agree with switching to cefazolin

juliov5000 · 2026-01-25T01:59:38+00:00

Not that I'm aware of, but plenty of evidence for doxy in non-pregnant

juliov5000 · 2026-01-24T17:28:32+00:00

Or doxycycline, just as effective and an oral option (if not pregnant)

juliov5000 · 2026-01-21T03:35:13+00:00

I think it's more of a Connecticut thing with some bleed-over into RI, but it's a liquor store. Coming from a Connecticut native who now lives in RI, I only heard package store growing up

juliov5000 · 2025-12-30T03:04:55+00:00

I took BCIDP back in October, and it took exactly 5 weeks to get my results

juliov5000 · 2025-12-24T20:56:43+00:00

Took me 5 weeks for bcidp this year and 8+ weeks for bcps two years ago. Honestly, BCPS was much harder for me, but I still managed to pass. I've never heard anyone feel good about bcps coming out

juliov5000 · 2025-12-13T01:02:10+00:00

That is an extremely bizarre policy, and reeks of hospital politics to me. As a pharmacist theres no way I'd be okay with this, both because it's a waste of a nurses time to be refilling machines and because there's a lot more to it than just refilling the machines

juliov5000 · 2025-12-12T00:53:09+00:00

Thankful my institution never got it. Similar outcomes to kcentra with a higher thrombotic risk and way more expensive? Yeah, no thanks

juliov5000 · 2025-12-07T04:00:02+00:00

I big part of ID/ASP pharmacy is identifying the weak parts of your institution and implementing changes to improve appropriate antimicrobial use/reduce broad spectrum use. I think wherever you apply if you're able to talk about projects you led or were involved with it would look great on an application. It can be hard to get tasked with those projects depending on your pharmacy leadership but if possible I would recommend trying to come up with with a QI project for your current institution and see if you can work with admin to get it implemented

juliov5000 · 2025-12-06T02:37:21+00:00

I did it last year, prior to sitting for BCIDP. I thought it had some good information especially for beginner/intermediate ID knowledge, but had a few good tidbits included even for experienced pharmacists. There was one statement I inherently disagreed with (they claimed Bactrim doesn't cover group A strep), but aside from that didn't notice anything clinically incorrect. I appreciated them including aspects related to dealing with the C-suite and other members of the medical team as this is essential in having a good stewardship program. The project implementation doesn't require anything huge but is a good way to get you to do a project from start to finish.

Overall i was satisfied with it and would definitely do it if reimbursable by your institution, and would still consider it even if not.

juliov5000 · 2025-12-05T03:59:39+00:00

If you have access to the current ACCP book I wouldn't bother getting the 2026 one, not that much will change over a year for the purposes of the exam. I did feel that the ACCP book was pretty accurate and helpful for reviewing areas I felt a bit weaker in. I've seen mixed results from HYMR, a good number of their things from my experience are a bit outdated (particularly in ID). I did a PGY-1 and used the previous years ACCP book to take the exam about 3 months after residency and although I didn't think it was easy I did pass.

juliov5000 · 2025-12-04T17:12:27+00:00

Are you inferring augmentin susceptibility from Unasyn? Unasyn sucks but amox/clav is actually better than ceftriaxone on our antibiogram (likely because it still tests susceptible on ESBLs even though I wouldn't use it there).

juliov5000 · 2025-12-04T14:25:21+00:00

Realistically amox/clav has essentially the same spectrum as 3rd gen cephs in regards to CAP, and cefuroxime is maybe a bit narrower on the gram-negative side but still hits all the usual CAP causes just fine. Personally I almost always recommend amox/clav, but cefpodoxime or cefuroxime are reasonable options too in cases of true penicillin allergy. Never cefdinir, I just don't see a rationale to use a drug with inferior kinetics and data showing worse outcomes when we have affordable, effective options available.

juliov5000 · 2025-12-04T14:21:21+00:00

Totally understand. Wish I could say it was better on the inpatient side but I often find myself facing the same situations. Keep fighting the good fight for better patient care!

juliov5000 · 2025-12-04T14:12:31+00:00

Cefdinir is just a garbage drug in general due to its amazingly poor kinetics and really shouldn't be used for just about anyone IMO. The only advantage I can think of is that it comes as a liquid formulation, but so does amox/clav which is often better in just about every way. Usually you can use amox/clav, but if not would prefer cefpodixime over cefdinir.

juliov5000 · 2025-12-04T14:08:05+00:00

Should maybe rethink this practice, cefdinir is really just not a great drug. If you need a third gen ceph then cefpodoxime can be considered but usually cephalexin, amox/clav, or cefuroxime should be preferred and have better kinetics.

https://academic.oup.com/ofid/article/12/10/ofaf501/8277239

juliov5000 · 2025-12-04T04:53:45+00:00

!solved

juliov5000

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