Breakpoints

Episode Notes

Join host Dr. Julie Ann Justo and guests Drs. Nicholas Mercuro and Andrew Haynes for the first installment of a two-part series on IV to PO antibiotic transition. Building on landmark studies such as POET, OVIVA, and SABATO, this episode explores the evidence supporting oral therapy for gram-positive bacterial infections, practical implementation strategies, pharmacokinetic and pharmacodynamic considerations, pediatric perspectives, and areas where clinicians may still have concerns about transitioning from IV to PO therapy.

References:

1.       https://sidp.org/SIDPEC, search for on-demand CE course from Drs. Jonathan Ryder & Esther Golnabi entitled, "Breaking Points: Landmark Studies that Shaped Infectious Diseases Pharmacotherapy Part 2: Advancing Oral Therapy" from 9/30/26

2.       SABATO: Kaasch AJ, et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. Lancet Infect Dis. 2024 May;24(5):523-534. doi: 10.1016/S1473-3099(23)00756-9. PMID: 38244557.

3.       Wilcox MH, et al. Complicated skin and skin-structure infections and catheter-related bloodstream infections: noninferiority of linezolid in a phase 3 study. Clin Infect Dis. 2009 Jan 15;48(2):203-12. doi: 10.1086/595686. PMID: 19072714.

4.       OVIVA: Li HK, et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection. N Engl J Med. 2019 Jan 31;380(5):425-436. doi: 10.1056/NEJMoa1710926. PMID: 30699315.

5.       BALANCE: BALANCE Investigators, Daneman N, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025 Mar 13;392(11):1065-1078. doi: 10.1056/NEJMoa2404991. PMID: 39565030.

6.       POvIV: Obremskey WT, et al. Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial. JAMA Surg. 2025 Mar 1;160(3):276-284. doi: 10.1001/jamasurg.2024.6439. PMID: 39841468.

7.       DATIPO: Bernard L, et al. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: 10.1056/NEJMoa2020198. PMID: 34042388.

8.       Gariani K, et al. Three Weeks Versus Six Weeks of Antibiotic Therapy for Diabetic Foot Osteomyelitis: A Prospective, Randomized, Noninferiority Pilot Trial. Clin Infect Dis. 2021 Oct 5;73(7):e1539-e1545. doi: 10.1093/cid/ciaa1758. PMID: 33242083.

9.       Tone A, et al. Six-week versus twelve-week antibiotic therapy for nonsurgically treated diabetic foot osteomyelitis: a multicenter open-label controlled randomized study. Diabetes Care. 2015 Feb;38(2):302-7. doi: 10.2337/dc14-1514. Epub 2014 Nov 20. Erratum in: Diabetes Care. 2015 Apr;38(4):735. doi: 10.2337/dc15-er04b. PMID: 25414157.

10.   POET: Iversen K, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019 Jan 31;380(5):415-424. doi: 10.1056/NEJMoa1808312. PMID: 30152252.

11.   Heldman AW, et al. Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users: prospective randomized comparison with parenteral therapy. Am J Med. 1996 Jul;101(1):68-76. doi: 10.1016/s0002-9343(96)00070-8. PMID: 8686718.

12.   Bactrim upfront: Paul M, et al. Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial. BMJ. 2015 May 14;350:h2219. doi: 10.1136/bmj.h2219. PMID: 25977146.

13.   Bactrim upfront: Markowitz N, Quinn EL, Saravolatz LD. Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection. Ann Intern Med. 1992 Sep 1;117(5):390-8. doi: 10.7326/0003-4819-117-5-390. PMID: 1503330.

14.   El-Dalati S, et al. Partial Oral Versus Intravenous Antibiotic Therapy for Endocarditis With Management by a Multidisciplinary Team: A Retrospective Cohort Study. Open Forum Infect Dis. 2025 Oct 28;12(10):ofaf625. doi: 10.1093/ofid/ofaf625. PMID: 41164785.

15.   IV to PO Algorithms: El-Dalati S, et al. Shared Decision-Making for Partial Oral Antibiotic Treatment of Infective Endocarditis: A Case Series. Open Forum Infect Dis. 2024 Mar 19;11(4):ofae166. doi: 10.1093/ofid/ofae166. PMID: 38585184.

16.   Freling S, et al. Real-World Application of Oral Therapy for Infective Endocarditis: A Multicenter, Retrospective, Cohort Study. Clin Infect Dis. 2023 Sep 11;77(5):672-679. doi: 10.1093/cid/ciad119. PMID: 36881940.

17.   DeSimone DC, et al. Infective Endocarditis: Diagnosis, Antibiotic Therapy, and Management: A Scientific Statement From the American Heart Association. Circulation. 2026 Oct 13;154(15):e593-e619. doi: 10.1161/CIR.0000000000001466. PMID: 42708190.

18.   VanScoy BD, et al. Evaluation of Oral Tebipenem as a Step-Down Therapy following Intravenous Ertapenem against Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Hollow-Fiber In Vitro Infection Model. Antimicrob Agents Chemother. 2023 Mar 16;67(3):e0090822. doi: 10.1128/aac.00908-22. PMID: 36757190.

19.   Bock M, et al. Attainment of Target Antibiotic Levels by Oral Treatment of Left-Sided Infective Endocarditis: A POET Substudy. Clin Infect Dis. 2023 Jul 26;77(2):242-251. doi: 10.1093/cid/ciad168. PMID: 36947131.

20.   USCAST Presentation: Andes D. Oral cephalosporin STIC against S. aureus and E. coli. 2024 Dec. Accessed at https://www.uscast.org/presentations.

21.   Haynes AS, et al. Cephalexin Model-Informed Dosing Recommendations for Severe Infections: A Pooled Pharmacokinetic Analysis From Infancy to Adulthood. Open Forum Infect Dis. 2026 Sep 26;13(10):ofag611. doi: 10.1093/ofid/ofag611. PMID: 42898747.

22.   Woods CR, et al. Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. J Pediatric Infect Dis Soc. 2021 Sep 23;10(8):801-844. doi: 10.1093/jpids/piab027. PMID: 34350458.

23.   Hikmat S, et al. Efficacy and tolerability of high-dose cefalexin 45 mg/kg/dose (maximum 1.5 g) three times daily in children with bone and joint infections. J Antimicrob Chemother. 2025 Feb 3;80(2):409-412. doi: 10.1093/jac/dkae423. PMID: 39568056.

24.   Ongoing BEST trial of high-dose oral cephalexin among pediatric patients with bone and joint infections in Australia and New Zealand: BonE and Joint Infections - Simplifying Treatment in Children Trial (BEST). Clinicaltrials.gov. 2026 Oct. NCT04538053.

25.   Breakpoints Episode #61 – Dosing Consult – Linezolid Therapeutic Drug Monitoring. 2022 Aug 22. Accessed at https://breakpoints-sidp.org/61-dosing-consult-linezolid-therapeutic-drug-monitoring/.

26.   Walls G, et al. Patient-reported Perceptions, Experiences, and Preferences Around Intravenous and Oral Antibiotics for the Treatment of Staphylococcus aureus Bacteremia: A Descriptive Qualitative Study. Clin Infect Dis. 2026 Apr 30;82(4):e635-e642. doi: 10.1093/cid/ciaf522. PMID: 40988120.

27.   Nursing time for IV vs. PO: Jenkins A. IV to oral switch: a novel viewpoint. J Antimicrob Chemother. 2023 Oct 3;78(10):2603-2604. doi: 10.1093/jac/dkad239. PMID: 37549305.

28.   Antibiotic Waste Calculator. Accessed at https://ecorxchoice.com.

29.   Juskowich JJ, et al. Using the Comparing Oral versus Parenteral Antimicrobial Therapy (COPAT) Clinical Trial to Influence Institutional Practice Transformation Towards Earlier Transition to Oral Antibiotics. Clin Infect Dis. 2026 Apr 30;82(4):e674-e681. doi: 10.1093/cid/ciaf707. PMID: 41419216.

30.   Hawkins MR, et al. Implementing Oral Antibiotics for Bone and Joint Infections: Lessons Learned and Opportunities for Improvement. Open Forum Infect Dis. 2024 Nov 16;11(12):ofae683. doi: 10.1093/ofid/ofae683. PMID: 39660026.

31.   MaineHealth Oral Switch Guideline: Schulz J, et al. Unlocked PO-tential: Impact of an Oral Switch Guideline for Osteomyelitis. 2026 MAD-ID & SIDP Annual Meeting. 2026 May 14-17, Orlando, FL. For a pdf of the poster, please email Nicholas Mercuro, PharmD at Nicholas.Mercuro@mainehealth.org

32.   Ongoing VA INTREPID Trial: Investigation of Rifampin to Reduce Pedal Amputations for Osteomyelitis in Diabetics (VA INTREPID). Clinicaltrials.gov. 2026 Apr. NCT03012529.

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Episode Notes

Join host Dr. Whitney Buckel and guests Drs. Priya Nori and Brad Langford as they highlight recent publications from Antimicrobial Stewardship & Healthcare Epidemiology (ASHE). This episode explores antimicrobial stewardship workforce trends, leadership competencies, innovative educational strategies, and environmental sustainability, with practical takeaways to help stewardship professionals strengthen programs and advance patient care

References:

Breakpoints: The SIDP Podcast. Episode 133: Trash Talk: Earth Day Special on Healthcare Sustainability and Stewardship. Released on April 16, 2026. Available at:Breakpoints website

CASCADES website: CASCADES – Creating a Sustainable Canadian Health System in a Climate Crisis

Hirsch EB, Mott DA, Gilson AM, Aitken SL, Basalyga V, Bergman SJ, Buckel WR, DeSear KE, Farber M, Gaither CA, Gross AE. A national survey of the infectious diseases and antimicrobial stewardship pharmacist workforce in the United States: work settings, characteristics, employment activities, resources and needs. Antimicrobial Stewardship & Healthcare Epidemiology. 2026 Jan;6(1):e76.

Holubar M, Bhowmick T, Buckel WR, Cosgrove SE, Evans C, File Jr TM, Fitzpatrick M, Leung E, Malani AN, Rios A, Preusker J, Nori P. Guidance for the Knowledge and Skills required for Antimicrobial Stewardship Leaders: an update from the Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Antimicrobial Stewardship & Healthcare Epidemiology. 2026 Jan;6(1):e130. 

Jeffres MN, McCann T, Salam ME, Brade KD. Seven days, seven quests: gamification to enhance engagement with antimicrobial stewardship resources during Antibiotic Awareness Week. Antimicrobial Stewardship & Healthcare Epidemiology. 2026 Jan;6(1):e72. 

Langford BJ, Baily P, Livorsi DJ, et al. Five steps to high quality antimicrobial stewardship research. Antimicrob Steward Healthc Epidemiol. 2024 May 9;4(1):e82. 

Lee PS, Gordon H, Ferguson T, Dinh T, Vu M, Nguyen M, Hsiao C, Fong G. EcoRxChoice.com- an SIDP-funded calculator integrating environmental metrics with antimicrobial stewardship. Antimicrob Steward Healthc Epidemiol. 2026 Jul 6;6(1):e199. 

Sustainabil-ID website: Sustainabil-ID

The ASHE Podcast. Episode 32: A Survey of the Infectious Diseases and Antimicrobial Stewardship Pharmacist Workforce in the United States. Released on June 25, 2026. Available via Apple Podcasts or Spotify.

The ASHE Podcast. Episode 35: Guidance for the Knowledge and Skills required for Antimicrobial Stewardship Leaders. Released August 19, 2026. Available via Apple Podcasts or Spotify.

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Episode Notes

Join host Dr. Ryan Moenster and guests Drs. Kaitlyn Rivard and Ross England as they discuss current strategies for preventing RSV in infants. Topics include maternal vaccination, long-acting monoclonal antibodies, differences between available products, safety considerations, vaccine hesitancy, and practical implementation strategies to help protect infants from severe RSV disease. Don't miss this timely discussion packed with expert insights and practical pearls for clinicians caring for infants and families during RSV season.

Funding for this podcast was provided by Sanofi

Reference:

1.      Hammitt LL, Dagan R, Yuan Y, et al. Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants. N Engl J Med. 2022 Mar 3;386(9):837-846. doi: 10.1056/NEJMoa2110275. PMID: 35235726.

2.      Bebia Z, Reyes O, Jeanfreau R, et al. Safety and Immunogenicity of an Investigational Respiratory Syncytial Virus Vaccine (RSVPreF3) in Mothers and Their Infants: A Phase 2 Randomized Trial. J Infect Dis. 2023 Aug 11;228(3):299-310. doi: 10.1093/infdis/jiad024. PMID: 36722147; PMCID: PMC10420396.

3.      Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023 Apr 20;388(16):1451-1464. doi: 10.1056/NEJMoa2216480. Epub 2023 Apr 5. PMID: 37018474.

4.      Wilkins D, Wählby Hamrén U, Chang Y, et al. RSV Neutralizing Antibodies Following Nirsevimab and Palivizumab Dosing. Pediatrics. 2024 Nov 1;154(5):e2024067174. doi: 10.1542/peds.2024-067174. PMID: 39350745.

5.      Pérez Marc G, et al. Real-world effectiveness of RSVpreF vaccination during pregnancy against RSV-associated lower respiratory tract disease leading to hospitalisation in infants during the 2024 RSV season in Argentina (BERNI study): a multicentre, retrospective, test-negative, case-control study. Lancet Infect Dis. 2025;25:1044-1054.

6.      Simões EAF, et al. Efficacy, safety, and immunogenicity of the MATISSE (Maternal Immunization Study for Safety and Efficacy) maternal respiratory syncytial virus prefusion F protein vaccine trial. Obstet Gynecol. 2025;145:157-167.

7.      Zar HJ, Simões EAF, Madhi SA, et al. Clesrovimab for Prevention of RSV Disease in Healthy Infants. N Engl J Med. 2025 Oct 2;393(13):1292-1303. doi: 10.1056/NEJMoa2502984. Epub 2025 Sep 17. PMID: 40961446.

8.      Zar HJ, Bont LJ, Manzoni P, et al. Clesrovimab in Infants and Children at Increased Risk for Severe RSV Disease. N Engl J Med. 2025 Oct 2;393(13):1343-1345. doi: 10.1056/NEJMc2506107. Epub 2025 Sep 17. PMID: 40961423.

9.      Banooni P, et al. Efficacy, immunogenicity, and safety of an investigational maternal respiratory syncytial virus prefusion F protein-based vaccine. Clin Infect Dis. 2026;82:e146-e155.

10. Jabagi M-J, et al. Nirsevimab vs RSVpreF vaccine for respiratory syncytial virus-related hospitalization in newborns. JAMA. 2026;335:787-798.

11. Moline HL, et al. Effectiveness and impact of maternal RSV immunization and nirsevimab on medically attended RSV in US children. JAMA Pediatr. 2026;180:314-324.

12. Shittu E, Pahud BA, Radley D, Gurtman A, Munjal I. Efficacy and safety outcomes from the MATISSE phase 3 trial of maternal bivalent RSVpreF vaccination among pregnant women vaccinated at 32 to 36 weeks of gestation. Swiss Med Wkly. 2026;156:4711.

13. Committee on Infectious Diseases. Recommendations for the Prevention of RSV Disease in Infants and Children: Policy Statement. Pediatrics. 2026 Sep 2. doi: 10.1542/peds.2026-079047. Epub ahead of print. PMID: 42683691.

14. Valtuille Z, et al. Effectiveness of nirsevimab immunisation after birth versus RSVpreF maternal vaccination in preventing RSV-related hospitalisations in infants: a population-based retrospective cohort study. Lancet Child Adolesc Health. 2026;10:481-490

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Does oseltamivir harm critically ill patients with influenza? In this Breakpoints and Communicable collaboration, Erin McCreary and Josh Davis are joined by Steve Webb and Steve Tong to discuss the REMAP-CAP trial results that are challenging a long-standing intensive care practice. Together, they review the study design, key findings, and implications for clinical care, while highlighting the importance of randomized clinical trials in shaping evidence-based medicine. At the time of recording, the REMAP-CAP results were available as a preprint.

Resources:

· REMAP-CAP: A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia, https://www.remapcap.org/

References:

1. Murthy S, et al. Oseltamivir for Critically Ill Patients with Influenza: A Randomised Trial. Lancet 2026. Preprint http://dx.doi.org/10.2139/ssrn.7172531

Learn more about the Society of Infectious Diseases Pharmacists: https://protect2.fireeye.com/v1/url?k=4063f96c-1ff8c1be-4063b7ad-867b1e11f55a-4ebd02e8eaa2fcc2\&q=1\&e=caf63b63-0143-4fa9-a81b-8d3031af3116\&u=https%3A%2F%2Fsidp.org%2FAboutSIDP – About

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X: SIDP (@SIDPharm) / X

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

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Dr. Prathit Kulkarni, lead author of a recent state-of-the-art review on acute and chronic bacterial prostatitis, joins host Dr. Erin McCreary to discuss this complex disease state. They walk through diagnosis, epidemiology, treatment, and more. You won’t want to miss this episode!

References:

1. Kulkarni PA, Cortés-Penfield NW, Brehm TJ, et al. State-of-the-Art Review: Diagnosis and Management of Acute and Chronic Bacterial Prostatitis. Clin Infect Dis. 2026;82(1):1-13. doi:10.1093/cid/ciaf483

Learn more about the Society of Infectious Diseases Pharmacists: SIDP - About

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LinkedIn:  https://www.linkedin.com/company/sidp/

X: SIDP (@SIDPharm) / X

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member