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Shamaei-Tousi is a principal clinical scientist at Debiopharm.

A small phase 2 study evaluated Debiopharm’s investigational antibiotic, afabicin, including its clinical response rate and safety profile of 2-3 weeks of treatment for staphylococcal bone and joint infections (BJI). 

Early-Stage Antibiotic for Bone and Joint Infections Comparable to Standard of Care Therapy

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

A small phase 2 study evaluated Debiopharm’s investigational antibiotic, afabicin, including its clinical response rate and safety profile of 2-3 weeks 

One source of bone and joint infections (BJI) can be from recent surgery including joint replacement procedures. It is estimated that over 2.9 million joint replacements are done globally every year.

BJI include osteomyelitis, septic arthritis, and prosthetic joint infections and affect over 30,000 people per year within the US, UK, France, Germany, Spain and Italy combined.

These infections can be especially troublesome to treat for a number of reasons including resistance to 

, blood flow sources to bones and also the time of treatment, which can typically be 4-6 weeks, with antibiotics that can cause toxicity and lead to adverse effects.

This last component of treatment toxicity can be very problematic according to Alireza Shamaei-Tousi, PhD, principal clinical scientist, Debiopharm.

"There is issues with safety and monitoring of some of these patients. For example, if you use vancomycin, it can be associated with cytopenia and ototoxicity,” Shamaei-Tousi said. "Also, if you use linezolid, because of cytopenia and other toxicity issues, the patient can only be given linezolid for 28 days. So you see there is an issue that becomes apparent if you want to have 6 weeks of treatment.” 

Debiopharm, a privately-owned, Swiss-based, biopharmaceutical company is in a phase 2 trial evaluating its investigational antibiotic, afabicin, for the treatment of BJI due to staphylococci.

Shamaei-Tousi presented a poster, Results from A Phase 2 Clinical Trial for Treatment of Bone And Joint Infections with Afabicin, A First-in-Class Selective Anti-Staphylococcal Antibiotic, at the recent ID Week conference.

This was a small study including 20 patients in the first cohort of the overall study and included 2-3 weeks of treatment.

Shamaei-Tousi says afabacin is available in both IV and oral treatment. This might be an option for patients requiring longer treatment who may start with the former and can be switched to oral after discharge. 

Study participants included in the study had osteomyelitis, septic arthritis, or prosthetic joint infections, and were randomized with 5 afabicin vs 1 standard of care (SoC) to receive IV and oral treatment for 14 to 21 days. Afabicin treatment was administered as 55 mg IV/ 80 mg PO BID, and was compared to a pre-defined SoC treatment, according to the investigators.

Seventeen patients were administered afabicin and 3 were given SoC. The mean treatment duration was 20.1 days for the afabicin arm, and 19.7 days for the SoC arm. Osteomyelitis was identified in 85% of the participants, and 

 was in 19 patients and 18 patients had methicillin-sensitive 

The investigators reported that all of the participants responded to treatment with a a clinical response at 4 weeks post end of treatment (EoT) was 13 of 15 patients in the afabicin arm. All 3 patients in the SOC arm achieved clinical response at 4 weeks post EoT. 

At 12 weeks post EoT, the clinical response rate was 13 of 15 patients in the afabicin arm and 2 of 3 patients in the SoC arm. The investigators noted a similar safety profile was observed in the afabicin cohort vs the SoC cohort. 3

“The clinical response rate and safety profile of 2-3 weeks treatment of staphylococcal BJI with afabicin was comparable to SoC. These data support exploring longer durations of treatment in the study,” the investigators wrote.

Debiopharm is working on treatments to cure cancer and treat infectious diseases. The company is developing microbiome-sparing pathogen-specific FabI inhibitors, a new class of antibiotics with novel mechanism of action. Afabicin, the most advanced FabI inhibitor in the pipeline, inhibits the fatty acid synthesis in staphylococci by targeting the Fabl enzyme. According to the Debiopharm, the therapy fulfills all 4 World Health Organization’s 2020 innovativeness criteria, including it’s a new chemical class, new target, a new mode of action and no cross-resistance to other antibiotic classes. 

Afabicin is also being researched in staphylococcal acute bacterial skin and skin structure infections (ABSSSI). Debiopharm is continuing its studies of the investigational compound for BJI for patients requiring 4-6 weeks of treatment.

 “The recruitment can be a bit of challenge, but we are hoping by next year, we have completed the cohort with 4-6 weeks of treatment,” said Shamaei-Tousi.

1. Krieger K. Researchers Heal Heavy Metal Poisoning from Implants. UConn Today. November 8, 2023. Accessed December 9, 2024. https://today.uconn.edu/2023/11/researchers-heal-heavy-metal-poisoning-from-implants
2. Debiopharm to Showcase Research Results of Their First-In-Class Anti-Staphylococcal Program at IDWeek 2024 in Los Angeles. Debiopharm press release. October 15, 2024. Accessed December 9, 2024. 

https://www.debiopharm.com/drug-development/press-releases/debiopharm-to-showcase-research-results-of-their-first-in-class-anti-staphylococcal-program-at-idweek-2024-in-los-angeles/


3. Shamaei-Tousi A. (P-65) Results from A Phase 2 Clinical Trial for Treatment of Bone And Joint Infections with Afabicin, A First-in-Class Selective Anti-Staphylococcal Antibiotic. Presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.

In our latest roundtable series, we cover different therapies around COVID-19 treatment and prevention. Clinicians offer insights on antivirals and 

COVID-19 Therapy Roundtable: Defining the Virus Today and Treatment Options   

we are continuing our ongoing series of roundtables where we gather a group of clinicians together to talk about specific infectious disease topics. During these discussions, they offer approaches to clinical management as it relates to various diseases and infections.

In this first roundtable episode, the panel touched upon what COVID-19 is at the end of 2024, offered insights on some of the FDA approved antivirals, and the limited treatment options for pediatric patients.

The Centers for Disease Control and Prevention (CDC) views COVID-19 as an endemic virus.

 As it circulates in perpetuity, we will continue to witness ebbs and flows in its prevalence. And certainly during the holiday season, respiratory virus incidence rates can increase due to a number of factors including families and friends gathering together, a greater frequency of travel, and people are in closed environments because of the winter climate.

Clinicians, public health officials, and interested stakeholders will always stress the importance of vaccination as the best way to prevent or reduce the severity of COVID-19. However, people will continue to get infected, especially as the statistics for vaccination are down.

 report published a few weeks ago offered insights on the vaccination statistics so far into the respiratory virus season. “As of November 9, 2024, cumulative estimated coverage with 2024–2025 influenza and COVID-19 vaccines among adults aged ≥18 years was 34.7% and 17.9%, respectively. Estimated RSV vaccination coverage was 39.7% among adults aged ≥75 years and 31.6% among those aged 60–74 years at increased risk,” the authors wrote.

Our panel of clinicians for this roundtable series includes:

Tina Tan, MD, professor of Pediatrics, Feinberg School of Medicine, Northwestern University

Scott Roberts, MD, associate medical director of Infection Prevention, Yale School of Medicine

James Wilson, DO, FACP, FAWM, CTropMed, critical care physician in private practice

Michael Curulewski, PharmD, BCPS, BCIDP, BCGP infectious diseases and antimicrobial stewardship pharmacist, Endeavor health, Northwest Community Hospital

We will continue our conversation next week, so check back then for the latest episode.



References
1.Stein R. Is COVID endemic yet? Yep, says the CDC. Here's what that means. NPR. August 9, 2024. Accessed December 4, 2024.


https://www.npr.org/sections/shots-health-news/2024/08/09/nx-s1-5060398/covid-endemic-cdc-summer-surge


2.Kriss JL, Black CL, Razzaghi H, et al. Influenza, COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults — United States, Fall 2024. MMWR Morb Mortal Wkly Rep 2024;73:1044–1051. DOI: 

In our latest roundtable series, we discuss COVID-19 treatment management and prevention 4 years after the start of the pandemic.

COVID-19 Therapy Roundtable: What is the Virus Today, Treatment Options, and Addressing the Pediatric Population

One new study shows 30% of preteens and teens who were in a cohort of young people with Long COVID were still struggling with the condition 2 years after their initial acute SARS-CoV-2 infection.

evaluated a population of young people (11-17 years of age) who met the definition of Long COVID. The study’s investigators gathered data from the National Long COVID in Children and Young People (CloCk) study in England, which is the world’s largest longitudinal cohort study on Long COVID in children.

In the study were 12,632 participants, and of them, 943 young people tested positive for SARS-CoV-2. They were asked to respond to questions about symptoms at 4 intervals: 3 months, 6 months, 12 months, and 24 months after their first positive test 

For the 943 participants who tested positive, 233 met the research definition of Long COVID 3 months after their initial positive test. At the 6 month mark, 135 continued to maintain Long COVID symptoms. At 12 months, 94 continued to fulfill the Long COVID research definition.

The investigators reported that 68 of these 943 young people (7.2%) continued to have Long COVID when contacted 24 months after their initial positive test. At 24 months, 165 of the 233 young people (70%) who had Long COVID, and provided information at every time point in the research had recovered. A subset of this group (30%) had still not recovered from the condition 24 months later.

“Our findings show that for teenagers who fulfilled our research definition of Long COVID 3 months after a positive test for the COVID virus, the majority have recovered after 2 years. This is good news but we intend to do further research to try to better understand why 68 teenagers had not recovered,” study chief investigator and first author, Professor Sir Terence Stephenson, said in a written statement.

Vaccine’s Effect on Long COVID Prevention

, reported that the mRNA COVID-19 vaccine, BNT162b2 (Pfizer-BioNTech), was efficacious in reducing the risk of Long COVID outcomes in both children and adolescents.

Investigators looked at vaccination during the Delta and Omicron periods and they found during the Delta variant’s period being the dominant strain, the mRNA vaccine was 95.4% effective in reducing Long COVID in adolescents. During the Omicron phase, the vaccine was 75.1% effective in reducing Long COVID in adolescents, and was 60.1% effective in reducing Long COVID in children 

“Our findings indicated a high overall protective effect of BNT162b2 against long COVID during the period dominated by the Delta variant and moderate protective effects during the Omicron period,” the investigators wrote. “The estimated direct effects suggested that beyond the protective role of vaccination against SARS-CoV-2 infection, pre-infection vaccination does not significantly modify the likelihood of Long COVID (ie, conclusive or probable Long COVID as well as body-system-focused PASC condition clusters). The estimated direct and indirect effects indicated that the vaccine’s primary advantage in protecting against long COVID outcomes stems from its ability to reduce the risk of SARS-CoV-2 infection.”

It is important to note this was a large, real-world study of nearly 300,000 children and teens. The investigators included the following number of participants: “112,590 adolescents (88,811 vaccinated) were included in the cohort for the analysis against Delta variant, and 188,894 children (101,277 vaccinated), and 84,735 adolescents (37,724 vaccinated) were included for the analysis against Omicron variant.”

They gathered data from 20 health systems in the RECOVER PCORnet electronic health record program. There were 3 independent cohorts including adolescents that were ages 12–20 years during the Delta phase, and children that were ages 5–11 years, and adolescents again that were ages (12–20 years) during the Omicron phase.

“This study profoundly enriches our understanding of the BNT162b2 vaccine’s impact on Long COVID risks within the US pediatric demographic, emphasizing the critical role of vaccination and infection prevention in public health policymaking,” the investigators concluded.

1.Stephenson, T, Pinto Pereira, SM, Nugawela, M.D. 

 A 24-month National Cohort Study examining long-term effects of COVID-19 in children and young people. 

 4, 255 (2024). https://doi.org/10.1038/s43856-024-00657-x
2.70% of young people with long Covid recover within two years. Eurekalert press release. December 4, 2024. Accessed December 7, 2024.
https://www.eurekalert.org/news-releases/1066700
3.Wu Q et al. Real-world effectiveness and causal mediation study of BNT162b2 on long COVID risks in children and adolescents. December 6, 2024.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00541-8/fulltext

With some young people still feeling the lingering effects of Long COVID years later, new data shows the value of COVID-19 vaccination to prevent the condition altogether. 

COVID-19 Vaccination Effective in Preventing Long COVID in Young People 

Adalja outlined the importance of recognizing antibiotic resistance in healthcare settings, educating patients on responsible antibiotic use, and the need for new treatments and diagnostic tools.8

More Bugs, No Drugs: The Growing Threat of Antibiotic Resistance

Antibiotic resistance, particularly the rise of superbugs, bacteria resistant to multiple antibiotics, has become a challenge in modern healthcare. Amesh A Adalja, MD, FIDSA, a senior scholar at the Johns Hopkins Center for Health Security, and an adjunct assistant professor at the Johns Hopkins Bloomberg School of Public Health, practicing infectious disease physician, and spokesperson for the Infectious Disease Society of America (IDSA), discussed the growing issue of antibiotic resistance and its impact on healthcare.

Adalja explained that the term “superbug” is not a formal medical classification but refers to bacteria that have developed resistance to multiple antibiotics. “Superbugs are not a medical term or a medical class. They’re a way of denoting bacteria that have become resistant to multiple different classes of antibiotics, giving them kind of an additional power to infect and cause disease, because there are limited to no countermeasures you can use against them due to the level of resistance they’ve evolved.” This resistance makes these bacteria much harder to treat and control.

Combating Antibiotic Resistance in Healthcare Institutions

Adalja emphasized that healthcare institutions need to prioritize antibiotic resistance and take proactive steps to address the issue. “The first thing that institutions need to do is recognize that these are a major problem and not just something that infectious disease doctors continually harp about,” he said. “They can really disrupt hospital operations in the form of causing outbreaks... in addition to making it very difficult for surgeries to occur if somebody is colonized with a drug-resistant bacteria.”

Acknowledging the problem is just the first step. Dr. Adalja noted that hospitals must invest in infection control resources and adopt modern diagnostic tools. “Many hospitals don’t adequately resource infection control and infectious disease departments, where there are not enough personnel or people doing multiple jobs, one person doing multiple jobs,” he said.

He also pointed out the importance of implementing advanced diagnostic methods. “There are many diagnostic tests that can be put in place in microbiology labs, very modern things that enable clinicians to understand what's going on much faster, to link people to the correct treatment, to understand there’s a resistance problem at a very granular level.”

Advanced technologies like whole genome sequencing can also help identify outbreaks and connect cases that might initially appear unrelated. “Things that don’t look linked, maybe, because they’re on different floors, might actually be linked,” he explained.

Ultimately, Adalja stressed that preventing antimicrobial resistance goes hand in hand with effective hospital infection control. “Combating antimicrobial resistance makes patients safer and eventually will lead to a better and more successful healthcare facility.”

Educating patients on the responsible use of antibiotics is another key strategy in tackling antibiotic resistance. Adalja advised clinicians to start with the basics: “You have to educate them, starting with the very basics: having them understand why bacteria develop resistance, how they develop resistance, what antibiotics are capable of doing, and what they can’t do.”

He emphasized that antibiotics are not a cure-all and should only be used when appropriate. “Many infections are not going to be something that antibiotics are indicated for, and there are other treatments—maybe antivirals or symptomatic treatments—that could be used in lieu of antibiotics.”

Adalja also explained the long-term consequences of improper antibiotic use. “Using them, even if it might not cause adverse side effects in the patient, does cause adverse side effects in the bacteria that live in the patient.”

He noted that antibiotics are different from other medications, such as pain relievers, because their use can affect future generations of bacteria. “Your use of antibiotics can impact other people’s use of antibiotics in the future. It can drive evolution of another species.”

Clinicians should help patients understand that the overuse of antibiotics can have far-reaching consequences. “For too long, people kind of thought of antibiotics as something that were just like everything else, and didn’t think about the consequences,” he said. “We’re in a situation where we have bad bugs and no drugs. It’s very difficult to develop new antibiotics, and it is very costly to develop new antibiotics.”

Recent Advancements in Antibiotic Treatments

While the problem of antibiotic resistance continues to grow, there have been some recent advancements in diagnostics and treatment options. Adalja pointed out that diagnostic tools have improved, enabling clinicians to better differentiate between bacterial and viral infections. “We’re getting better at diagnosing infections and realizing that not everything that we once thought was a bacterial infection is a bacterial infection,” he said. This allows for more targeted treatment, such as antivirals for viral infections like influenza or COVID-19.

Adalja also mentioned several new antibiotics developed to treat highly resistant gram-negative bacteria. “We do have some new antibiotics that have been developed primarily to treat very resistant gram-negative drugs,” he explained. These include drugs like cefiderocol, imipenem-cilastatin/relebactam, ceftolozane-tazobactam, and meropenem-vaborbactam.

In addition to new antibiotics, researchers are exploring alternative treatments, such as bacteriophage therapy. “Bacteriophages are viruses that infect bacteria,” Adalja explained. “We’re starting to see bacteriophage therapy being something that is being tried in infections of last resort.” At centers like the University of Pittsburgh, bacteriophage therapy is being tested to treat resistant infections by matching a specific bacterial infection with a corresponding bacteriophage.

The Global Urgency of Antibiotic Resistance

The issue of antibiotic resistance is not just a medical challenge, but a global one, and Adalja emphasized the importance of addressing it at all levels. “It’s become a priority for the world,” he said. The United Nations recently held a high-level meeting to discuss the issue.

Adalja concluded by underscoring that antibiotics are essential for the continuation of modern medicine. “If we are to keep modern medicine functioning and advancing, organ transplantations and new cancer therapies, it’s going to be antibiotics that facilitate that, because infection is the major thing that we’re trying to prevent in those vulnerable patients.”

Amesh A. Adalja, MD, FIDSA outlined the importance of recognizing antibiotic resistance in healthcare settings, educating patients on responsible antibiotic use, and the need for new treatments and diagnostic tools.

3 minutes, 48 seconds

How soon do you assess into clinical care and what are you looking for when changing treatments or step-down?

 Once we start seeing clinical stability in these patients, our approach varies based on case-specific factors. For example, if a patient’s infection source is a wound and we have pending cultures, we may initially go broad due to concerns about polymicrobial infection. This requires us to monitor culture results, consider de-escalation, and ultimately shift toward optimal therapy. If it’s MSSA, we aim to transition to cefazolin or an antistaphylococcal penicillin. For MRSA, we focus on MRSA-specific therapies. However, it’s also important to consider the broader picture and long-term treatment plans.

Another factor we assess is whether the patient has a history of injection drug use, which is relevant for patients in our region, Savannah, Georgia, where IV drug use is prevalent. Knowing if they have a history of drug injection affects decisions regarding OPAT, outpatient transitions, and discharge planning.

In thinking about discharge, what are the factors you want to see in patients?

 I think this is a good time to mention the SABATO trial, which examined switching some low-risk patients to oral therapy after 5 to 7 days of IV treatment, once they had stabilized. Implementing this approach has been challenging here, and I think that’s true for many places. It’s a significant change in practice, moving away from the comfort of 4- to 6-week IV therapy regimens that many of us are used to.

Patient disposition also plays a big role, and this is where a multidisciplinary approach, particularly case management, becomes essential. In our health system, we conduct daily multidisciplinary rounds that bring together case managers, attending physicians, pharmacists, and nursing staff. Case managers play a crucial role in determining the patient's next steps and discharge plan. For us as pharmacists, knowing the patient's destination helps us prepare appropriately for their treatment needs in that setting.

For those patients who still need to receive outpatient therapy at an infusion center, does the treatment medication from inpatient to outpatient influence your initial therapy choice?

 The best answer I can give is that it depends. Our primary goal is to get patients on the most effective and optimized treatment possible. However, once the patient is stable, we have to start considering their discharge plan. Where are they going? Will they be going to a nursing home, managing home infusions for IV antibiotics, or visiting an infusion center? We have an on-site infusion center, which influences our approach.

The choice of agent may depend on the discharge setting. For example, if the patient will be going to a location where only once-daily dosing is feasible, we may need to select a compatible agent. Cost is another factor, as the patient’s insurance coverage—or lack thereof—affects our options.

With an infusion center, one limitation we encounter is the need for once-daily (Q24) dosing, as more frequent schedules, like Q12, Q8, or Q6, aren’t always practical. One way to address this is by using certain agents, like beta-lactams, as continuous infusions, allowing us to maintain effective treatment with a once-daily dosing model.

Jones offered his insights for discharging patients as well as follow-up outpatient treatment.

Alireza Shamaei-Tousi, PhD

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