![\"\"](\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/01\/Skiing_in_the_East_LCCN98514616.jpg\")
<\/a>Source: Work Projects Administration Poster Collection [Public domain], via Wikimedia Commons<\/p><\/div>Here are some “quick questions” with an ID theme for people to consider as we head into week 3 of 52 of this new year.<\/p>\n
Just think, by the end of next week, we’ll be nearly 6% done with the new year. How time flies!<\/p>\n
For the various items below, if people know the answers, or want to speculate, have at it in the comments section.<\/p>\n
- \n
- For patients with a nagging cough, what is the median time before they receive an antibiotic?<\/strong> I’m referring to actual clinical practice, also known as “the real world.” And break it down between adults and kids, please.<\/li>\n
- And for these same treated patients, what percentage receive azithromycin?\u00a0<\/strong>One estimate has it as 99.9621%.<\/li>\n
- Since vancomycin plus piperacillin-tazobactam increases the risk of acute kidney injury<\/a>, does this mean less empiric “Vancosyn” in acute care hospitals? <\/strong>Anecdotally, I think<\/em> it’s having an effect at our hospital — time will tell.<\/li>\n
- When will PJP replace PCP as the preferred abbreviation for Pneumocystis jirovecii<\/em> pneumonia?<\/strong> More and more residents and fellows seem to be using the former, so that day will come soon. Sorry old-timers!<\/li>\n
- In low TB prevalence regions, what percentage of patients admitted to the hospital with a low clinical suspicion of TB<\/em> but who undergo a TB rule out “just in case” actually have TB?\u00a0<\/strong>One estimate has it at 0.0379% (the inverse of the azithromycin estimate above … shocking coincidence). Only our careful Infection Control colleagues can say if this is worth it.<\/li>\n
- When will improved approaches to Lyme testing be available in the clinic?<\/strong>\u00a0Whether it’s serologic tests<\/a>, or\u00a0metabolic changes<\/a>, or (even better), a reliable PCR or antigen test, here’s hoping this happens soon. Spoiler alert if you haven’t listened to this podcast<\/a>\u00a0— and what are you waiting for? — but this is my least favorite test.<\/li>\n
- Will the new zoster vaccine be more broadly adopted than our current one?<\/strong> It’s more effective, more cost-effective<\/a>, and will be easier to store and distribute, but vaccine acceptance is a tricky business. Factors will include ACIP guidelines, cost and insurance coverage, post-approval safety, and marketing — both to clinicians and direct to patients. Speaking of zoster…<\/li>\n
- Why do so many patients think you can “catch” a case of shingles from someone else?\u00a0<\/strong>Not referring to primary acquisition of VZV in a non-immune person — that of course can happen. I mean someone getting shingles (zoster) shortly after seeing another person with shingles. Patients continue to think this even after the whole difference between chicken pox and shingles is explained.<\/li>\n
- Did anti-vaccine stupidity reach a new high with this recent Australian case<\/a>?<\/strong> The father, who had measles as a child, stated he passed on his “natural immunity” to the disease to his children, so they didn’t need the vaccine. Yikes. (H\/T to Keith Law<\/a> for the link.)<\/li>\n
- What proportion of ID doctors just say “isavuconazole” rather than the full name, “isavuconazonium”?<\/strong>\u00a0This critical (and I mean critical<\/em>) issue came up right after it’s approval, but now that it’s been out for a while, I’m thinking nearly all of us say the shorter “isavuconazole” — which isn’t so easy to say itself.<\/li>\n
- Why can’t there be a single<\/em> meningitis vaccine that includes all five serotypes?<\/strong>\u00a0No doubt there is some immunologic reason, right? Or is it part of the great conspiracy to make meningococcal immunization guidelines as confusing as possible?<\/li>\n
- Does oseltamivir actually work?<\/strong>\u00a0Depends who you ask. Efficacy debates notwithstanding, we sure use a whole lot of it.<\/li>\n
- Is there any medical reason to use the TDF versions of the elvitegravir- and rilpivirine-containing single tablet treatments for HIV?\u00a0<\/strong>I can’t think of one; always surprises me when encountering someone who hasn’t switched.<\/li>\n
- What’s the correct dose of daptomycin?<\/strong>\u00a0Now for the quick answer:\u00a0 Nobody knows!<\/li>\n
- Has the price of any other other oral antibiotic ever dropped as fast, and by as much, as linezolid?<\/strong> A year ago, two weeks of linezolid cost $3600; today it’s $150<\/a>. Wow.<\/li>\n
- How many people need to respond to a piece of academic spam — a bogus meeting invitation, or a predatory journal request for submissions — for these emails to become profitable for the senders?<\/strong> There has to be a number, or else this annoying stuff wouldn’t proliferate so wildly.<\/li>\n<\/ul>\n
\n
Per Journal of Infectious Diseases Editor-in-Chief Marty Hirsch, a short list of copycat predatory journals over the years — with my personal, all-inclusive favorite highlighted! #academicspam<\/a> pic.twitter.com\/4Xy7VEpDnw<\/a><\/p>\n
— Paul Sax (@PaulSaxMD) December 31, 2017<\/a><\/p><\/blockquote>\n
- And for these same treated patients, what percentage receive azithromycin?\u00a0<\/strong>One estimate has it as 99.9621%.<\/li>\n