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#124 – Dosing Consult: Cefepime
Drs. Erin Barreto (@erin_barreto) and Jeffrey Lipman join Dr. Whitney Buckel for a conversation on ideal dosing of cefepime. Hear from the experts on the differences between package insert and “high-dose” regimens, adjustments for renal impairment/augmented renal clearance, and the role of cefepime therapeutic drug monitoring. References: Barreto EF, et al. Setting the Beta-Lactam Therapeutic Range for Critically Ill Patients: Is There a Floor or Even a Ceiling? Crit Care Explor. 2021 Jun 11;3(6):e0446.PMID: https://pubmed.ncbi.nlm.nih.gov/34136822/ Barreto EF, et al. Adequacy of cefepime concentrations in the early phase of critical illness: A case for precision pharmacotherapy. Pharmacotherapy. 2023 Nov;43(11):1112-1120. https://pubmed.ncbi.nlm.nih.gov/36648390/ ** **Udy AA, et al. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49(1):1-16. https://pubmed.ncbi.nlm.nih.gov/20000886/ Lipman J, Wallis SC, Boots RJ. Cefepime versus cefpirome: the importance of creatinine clearance. Anesth Analg. 2003 Oct;97(4):1149-1154. doi: 10.1213/01.ANE.0000077077.54084.B0.PMID: 14500173 Roberts JA, Ulldemolins M, Roberts MS, McWhinney B, Ungerer J, Paterson DL, Lipman J. Therapeutic drug monitoring of beta-lactams in critically ill patients: proof of concept. Int J Antimicrob Agents. 2010 Oct;36(4):332-9. doi: 10.1016/j.ijantimicag.2010.06.008. Epub 2010 Aug 3.PMID: 20685085
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#122 – The Role of The Pharmacist in Antimicrobial Stewardship in Latin America
In our first episode released in both English and Spanish, Drs. Laila Woc-Colburn and Nicholás Ignacio Valdebenito Farías join Dr. José Pablo Díaz Madriz to discuss the role of the pharmacist in antimicrobial stewardship in Latin America. They discuss the need for growth of antimicrobial stewardship programs across Latin America, how pharmacists can expand their roles to support multidisciplinary antimicrobial stewardship teams, and much more! Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Emerg Infect Dis. 2023 Nov;29(11):2335-44. doi:10.3201/eid2911.230753. PMID:37877573; PMCID:PMC10617342. Antimicrobial Resistance Collaborators. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am. 2023 Aug 8;25:100561. doi:10.1016/j.lana.2023.100561. Erratum in: Lancet Reg Health Am. 2023 Nov 10;28:100632. doi:10.1016/j.lana.2023.100632. PMID:37727594; PMCID:PMC10505822. Fabre V, Secaira C, Cosgrove SE, Lessa FC, Patel TS, Alvarez AA, Anchiraico LM, Del Carmen Bangher M, Barberis MF, Burokas MS, Castañeda X, Colque AM, De Ascencao G, Esquivel C, Ezcurra C, Falleroni LA, Frassone N, Garzón MI, Gomez C, Gonzalez JA, Hernandez D, Laplume D, Lemir CG, Maldonado Briones H, Melgar M, Mesplet F, Martinez G, Pertuz CM, Moreno C, Nemirovsky C, Nuccetelli Y, Palacio B, Sandoval N, Vergara H, Videla H, Villamandos S, Villareal O, Viteri A, Quiros R. Deep dive into gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Latin America. Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S53-S61. doi:10.1093/cid/ciad184. PMID:37406044; PMCID:PMC10321692. Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Birgand G, Poda A, Ahmad R, Singh S, Holmes AH. Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries: a qualitative study. PLoS One. 2019 Jan 16;14(1):e0209847. doi:10.1371/journal.pone.0209847. PMID:30650099; PMCID:PMC6335060. Bavestrello L, Cabello Á, Casanova D. Impact of regulatory measures on antibiotic sales in Chile. Rev Med Chil. 2002 Nov;130(11):1265-72. doi:10.4067/S0034-98872002001100009. ISSN 0034-9887. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica. Rev Panam Salud Publica. 2020;44:e57. doi:10.26633/RPSP.2020.57. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: a retrospective study. J Am Coll Clin Pharm. 2022;5(11):1148-55. doi:10.1002/jac5.1708. Domínguez I, et al. Evaluación del consumo de antimicrobianos en 15 hospitales chilenos: resultados de un trabajo colaborativo, 2013. Rev Chil Infectol. 2016 Jun;33(3):307-12. doi:10.4067/S0716-10182016000300010. ISSN 0716-1018. Ministerio de Salud de Chile. Norma general técnica N°210 para la racionalización del uso de antimicrobianos en la atención clínica. Resolución Exenta N°1146, 2020. Disponible en: https://diprece.minsal.cl/wp-content/uploads/2021/01/RES.-EXENTA-N%C2%B01146-Aprueba-Norma-Gral.-Te%CC%81cnica-N%C2%B00210-para-la-racionalizacio%CC%81n-del-uso-de-antimicrobianos-en-la-Atencio%CC%81n-Cli%CC%81nica_v2.pdf
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#123 – Rol del Farmacéutico en los PROA en América Latina
En nuestro primer episodio publicado tanto en inglés como en español, la Dra. Laila Woc-Colburn y el QF. Nicolás Ignacio Valdebenito Farías se unen al Dr. José Pablo Díaz Madriz para hablar sobre el papel del farmacéutico en los PROA en América Latina. Ellos discuten la necesidad de expandir los PROA en toda la región, cómo los farmacéuticos pueden ampliar sus funciones para apoyar equipos multidisciplinarios dedicados a esta labor, ¡y mucho más! Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Emerg Infect Dis. 2023 Nov;29(11):2335-44. doi:10.3201/eid2911.230753. PMID:37877573; PMCID:PMC10617342. Antimicrobial Resistance Collaborators. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am. 2023 Aug 8;25:100561. doi:10.1016/j.lana.2023.100561. Erratum in: Lancet Reg Health Am. 2023 Nov 10;28:100632. doi:10.1016/j.lana.2023.100632. PMID:37727594; PMCID:PMC10505822. Fabre V, Secaira C, Cosgrove SE, Lessa FC, Patel TS, Alvarez AA, Anchiraico LM, Del Carmen Bangher M, Barberis MF, Burokas MS, Castañeda X, Colque AM, De Ascencao G, Esquivel C, Ezcurra C, Falleroni LA, Frassone N, Garzón MI, Gomez C, Gonzalez JA, Hernandez D, Laplume D, Lemir CG, Maldonado Briones H, Melgar M, Mesplet F, Martinez G, Pertuz CM, Moreno C, Nemirovsky C, Nuccetelli Y, Palacio B, Sandoval N, Vergara H, Videla H, Villamandos S, Villareal O, Viteri A, Quiros R. Deep dive into gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Latin America. Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S53-S61. doi:10.1093/cid/ciad184. PMID:37406044; PMCID:PMC10321692. Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Birgand G, Poda A, Ahmad R, Singh S, Holmes AH. Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries: a qualitative study. PLoS One. 2019 Jan 16;14(1):e0209847. doi:10.1371/journal.pone.0209847. PMID:30650099; PMCID:PMC6335060. Bavestrello L, Cabello Á, Casanova D. Impact of regulatory measures on antibiotic sales in Chile. Rev Med Chil. 2002 Nov;130(11):1265-72. doi:10.4067/S0034-98872002001100009. ISSN 0034-9887. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica. Rev Panam Salud Publica. 2020;44:e57. doi:10.26633/RPSP.2020.57. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: a retrospective study. J Am Coll Clin Pharm. 2022;5(11):1148-55. doi:10.1002/jac5.1708. Domínguez I, et al. Evaluación del consumo de antimicrobianos en 15 hospitales chilenos: resultados de un trabajo colaborativo, 2013. Rev Chil Infectol. 2016 Jun;33(3):307-12. doi:10.4067/S0716-10182016000300010. ISSN 0716-1018. Ministerio de Salud de Chile. Norma general técnica N°210 para la racionalización del uso de antimicrobianos en la atención clínica. Resolución Exenta N°1146, 2020. Disponible en: https://diprece.minsal.cl/wp-content/uploads/2021/01/RES.-EXENTA-N%C2%B01146-Aprueba-Norma-Gral.-Te%CC%81cnica-N%C2%B00210-para-la-racionalizacio%CC%81n-del-uso-de-antimicrobianos-en-la-Atencio%CC%81n-Cli%CC%81nica_v2.pdf
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#121 – Finding BALANCE in Antibiotic Durations: The BALANCE Trial
In this second-ever collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Angela Huttner invite the two principal investigators and visionaries who spearheaded the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) trial, Nick Daneman and Rob Fowler from Sunnybrook Health Sciences Centre in Toronto, for a “deep dive into all things that went into this trial.” The BALANCE trial spanned over ten years investigating - as the acronym title suggests - whether a shorter treatment duration of seven days was non-inferior to the standard of care of fourteen days for bacteremia. The conversation covers everything from the initial hallway discussions that sparked the trial, the trial itself that screened over 36,000 patients and enrolled +3,600, its impact on clinical practice, key takeaways, and what’s next for Daneman and Fowler. References: BALANCE Investigators, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025 March. DOI: https://doi.org/10.1056/NEJMoa2404991
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#120 – What’s Pneu in Community-Acquired Pneumonia
Drs. Whitney Hartlage (@whithartlage11) and Sam Windham join Dr. Ryan Moenster to discuss updates in the diagnosis and management of community-acquire pneumonia. Hear from our guests on the role of rapid diagnostic tests such as multiplex PCR and urinary antigen tests in the inpatient and outpatient setting, considerations for initiating steroids and withholding macrolides, and when to use short antibiotic durations. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena R, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492. Odeyemi Y, Tekin A, Schanz C, Schreier D, Cole K, Gajic O, Barreto E. Comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community acquired pneumonia treated with beta-lactams: A multicenter matched cohort study. Clin Infect Dis. 2025 May 16:ciaf252. doi: 10.1093/cid/ciaf252. Epub ahead of print. PMID: 40378193. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O'Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057; PMCID: PMC12355227. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ Open. 2023 Mar 22;13(3):e061023. doi: 10.1136/bmjopen-2022-061023. PMID: 36948555; PMCID: PMC10040075 Schober T, Wong K, DeLisle G, et al. Clinical outcomes of rapid respiratory virus testing in emergency departments. JAMA Intern Med. 2024;184(5):528-536. Clark T, Lindsley K, Wigmosta T, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at David Medical Center. J Clin Virol. 2023:168:105597. Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Østergaard C, et al. Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: a multicentre randomised controlled trial. PLoS Med. 2023;20:e1004314. doi: 10.1371/ journal.pmed.1004314. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-acquired pneumonia: a review. JAMA. 2024;332(15):1282-1295. Davis MR, McCreary EK, Trzebucki AM. Things we do for no reason – ordering Streptococcus pneumoniae urinary antigen in patients with community-acquired pneumonia. Open Forum Infect Dis. 2024;11(3):ofae089. Centers for Disease Control and Prevention. Laboratory Testing for Legionella. Updated June 9, 2025. Accessed July 13, 2025. https://www.cdc.gov/legionella/php/laboratories/index.html. Jain S, Self WH, Wunderink RG. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. Kamat IS, Ramachandram V, Eswaran H, Guffey D, Musher DM. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2020;70(3):538-542. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single blinded intervention trial. Lancet. 2004;363:600–7. doi: 10.1016/S0140- 6736(04)15591-8. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302:1059–66. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalci- € tonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Datab System Rev. 2017;10(10):CD007498. doi: 10.1002/14651858. cd007498.pub2. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang C-CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for lower Respiratory tract infection. New Engl J Med. 2018;379:236–49. doi: 10.1056/NEJMoa1802670. Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;389(19):1623-1634. doi:10.1056/NEJMoa2215145. Gupta AB, Flanders SA, Petty LA, et al. Inappropriate diagnosis of pneumonia among hospitalized adults. JAMA Intern Med. 2024;184(5):548-556. Jones BE, Chapman AB, Ying J, et al. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: A National Cohort Study of 115 U.S. Veterans Affairs Hospitals. Ann Intern Med. 2024;177(9):1179-1189. doi:10.7326/M23-2505. Hartlage W, Imlay H, Spivak ES. The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e214. doi:10.1017/ash.2024.453. Dinh A, Barbier F, Bedos JP, et al. Update of guidelines for management of community acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF). Endorsed by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF); endorsed by the French Intensive Care Society (SRLF), the French Microbiology Society (SFM), the French Radiology Society (SFR), and the French Emergency Society (SFMU). Respir Med and Res. 2025. El Moussaoui R, de Borgie CAJM, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006;332(7554):1355. doi:10.1136/bmj.332.7554.1355. Dinh A, Ropers J, Duran C, et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia: a randomized, non-inferiority trial. Lancet. 2021;397(10280):1195-1203.
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