Brad Spellberg @bradspellberg.bsky.social · 29/08/2026Congratulations @Wiki_Guidelines on publication of the latest guideline, on management of complications of persons who inject drugs! Great job team! Let's spread widely! amjmed.com/article/S0002-… @absteward.bsky.socialamjmed.com 093
Brad Spellberg @bradspellberg.bsky.social · 21/07/2026Sure, i think it’s fine to do. Apologies for slow response. I almost never come on this app anymore. 000
Reposted by Brad SpellbergAntibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 14/05/2026“Antibiotics are among the most potent psychoactive drugs in all the pharmacopoeia. They are incredibly potent anxiolytics.They just act on the prescriber rather than the patient” -Dr. Brad Spellberg @bradspellberg.bsky.social #idquotes #idsky 0153
Reposted by Brad SpellbergAntibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 21/04/2026Proud to be part of this great team led by @bradspellberg.bsky.social 🔥Our LTE is now published “Evidence Over Eminence: Rethinking Specialty Guidelines Amid the ATS–IDSA Debate.” A timely discussion on evidence vs eminence in the guidelines development. #IDsky academic.oup.com/cid/article/...academic.oup.comEvidence Over Eminence: Rethinking Specialty Guidelines Amid the ATS-IDSA DebateBrad Spellberg, MD, Bassam Ghanem, PharmD MS BCIDP, Miguel Morante-Ruiz, MD, Émilie Bortolussi-Courval, RN PhD, Anil N Makam, MD MAS, Zeynep Ergenc, MD, Ni 1178
Reposted by Brad SpellbergAntibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 06/05/2026Static vs. cidal: it’s not complex; it’s simply incorrect @bradspellberg.bsky.social et Al Honored to be part of this amazing group who challenges dogmas and debunk ID myths #idsky #microsky journals.asm.org/doi/10.1128/... 2136
Brad Spellberg @bradspellberg.bsky.social · 26/03/2026From '23-'25 LA General Medical Center underwent a once in a generation workforce transformation, caused by fiscal & regulatory pressure. Our article describing causes & outcomes is published! Critical lessons for health systems in a time of federal uncertainty. www.dovepress.com/articles.php...dovepress.com| JHL | Dove Medical PressKey lessons learned from the LA General transformation, including approaches taken to recruitment and culture change, and outcomes achieved. 030
Brad Spellberg @bradspellberg.bsky.social · 06/03/2026My friend we’re putting together a letter on this point. You want in? Email me and I’ll send you the link to participate. 050
Brad Spellberg @bradspellberg.bsky.social · 02/03/2026Hey @infectedterran.bsky.social, my brother in Scrubs! Have you seen it yet? Man, just watched the first episode and it was like coming home after a long journey. I really missed them, and the tone was just perfect. Whaddaya think? 110
Brad Spellberg @bradspellberg.bsky.social · 02/03/2026Happy to attend virtually! I’m sure Devin Clark would be willing to as well! He gets full credit for the study. 000
Brad Spellberg @bradspellberg.bsky.social · 28/02/2026Not so. Fidaxamicin did not provide longer term follow up. 110
Brad Spellberg @bradspellberg.bsky.social · 27/02/2026Right. But seems as good or better than fidaxo at a fraction of the cost. 361
Brad Spellberg @bradspellberg.bsky.social · 07/02/2026Yeah I’m with you. We did the stewardship intervention cuz it was so commonly inappropriately ordered. 000
Brad Spellberg @bradspellberg.bsky.social · 07/02/2026You mean, something like this? www.cambridge.org/core/journal...cambridge.orgReducing Clostridium difficile Colitis Rates Via Cost-Saving Diagnostic Stewardship | Infection Control & Hospital Epidemiology | Cambridge CoreReducing Clostridium difficile Colitis Rates Via Cost-Saving Diagnostic Stewardship - Volume 39 Issue 6 100
Brad Spellberg @bradspellberg.bsky.social · 01/02/2026Rock on my brother in ampho-hating! @drboulware.bsky.socialmedia.tenor.coma blue circle with a white hand making a call me gestureALT: a blue circle with a white hand making a call me gesture 050
Brad Spellberg @bradspellberg.bsky.social · 22/01/2026Oh, well if it’s the blue alien dudes from avatar then yeah i get your point. All available evidence indicates that amphotericin causes them to turn green (cuz, yellow + blue = green). And green, as everyone knows, is good. 010
Brad Spellberg @bradspellberg.bsky.social · 22/01/2026I know some folk think it shouldn’t be used for gatti. I can’t imagine why. Gatti doesn’t have higher fluc mics. It isn’t harder to kill. It’s more inflammatory & prone to infection in hiv-neg pts. Why would that mean AMBITION won’t work? Burden of proof is on the more harmful Tx, not the safer one. 130
Reposted by Brad SpellbergBrad Spellberg @bradspellberg.bsky.social · 21/01/20260 reason to think things would be difft in non HIV, children, xenomorphs, non carbon based life forms, or any other excuses stubborn deniers have. My suggestion? Do some yoga. Meditate. Light incense. Relax. And stop torturing your patients with 2 weeks of amphoterrible. Subtle as always, I know. 322
Brad Spellberg @bradspellberg.bsky.social · 21/01/20260 reason to think things would be difft in non HIV, children, xenomorphs, non carbon based life forms, or any other excuses stubborn deniers have. My suggestion? Do some yoga. Meditate. Light incense. Relax. And stop torturing your patients with 2 weeks of amphoterrible. Subtle as always, I know. 322
Brad Spellberg @bradspellberg.bsky.social · 21/01/2026And a congratulations to the humble @drboulware.bsky.social, who published a thoughtful editorial accompanying the study. Dr. Boulware is a true leader in ID, and it is an honor to have him evaluate our study. I encourage everyone to read his team's editorial! jamanetwork.com/journals/jam...jamanetwork.comSingle-Dose Amphotericin B for HIV-Related Cryptococcal MeningitisCryptococcal meningitis remains a life-threatening opportunistic infection among people with advanced HIV, even in high-resource settings. For decades, the standard induction regimen in the United Sta... 170
Brad Spellberg @bradspellberg.bsky.social · 21/01/2026Thank you my friend! Based on your original work!!!! US docs gotta get on board & stop pretending things that work in other countries won't work in US. AMBITION protocol is MUCH safer and MUCH more patient centered, and just as effective as 2 weeks of old, sad, amphoterrible. @absteward.bsky.social 0103
Reposted by Brad SpellbergDr. D Boulware, MD MPH @drboulware.bsky.social · 21/01/2026Patient-directed discharges (i.e. leaving against medical advice) dropped from 35% to 12%. Major congratulations to the authors: Devin Clark, Brad Spellberg @bradspellberg.bsky.social , and colleagues. 0152
Reposted by Brad SpellbergDr. D Boulware, MD MPH @drboulware.bsky.social · 21/01/2026In an excellent study of real world outcomes in LA General Medical Center, after implementing AMBITION single dose liposomal amphotericin protocol for crypto meningitis: Similar survival without recurrence Fewer severe adverse events Shorter hospitalization (lower cost) dx.doi.org/10.1001/jama... 1145
Reposted by Brad SpellbergDr. D Boulware, MD MPH @drboulware.bsky.social · 21/01/2026Is It Time to Use Single-Dose Amphotericin B for HIV-Related Cryptococcal Meningitis in the USA? The answer is yes! doi.org/10.1001/jama...doi.orgSingle-Dose Amphotericin B for HIV-Related Cryptococcal MeningitisCryptococcal meningitis remains a life-threatening opportunistic infection among people with advanced HIV, even in high-resource settings. For decades, the standard induction regimen in the United Sta... 52311
Brad Spellberg @bradspellberg.bsky.social · 12/01/2026As above, I’m good with mono therapy linezolid 010
Brad Spellberg @bradspellberg.bsky.social · 12/01/2026I’m fine with oral linezolid as mono therapy. I do tend to use dual for others (amox+rif, amox+FQ, FQ+rif). But that’s cuz I’m chicken. Not because I’m really sure it’s needed. 110
Brad Spellberg @bradspellberg.bsky.social · 05/01/2026Do you remember those old beer commercials? “Why ask why? Try Bud Dry.” All this isolation stuff is non evidenced based nonsense. Cluster randomized trials have shown it doesn’t work. We no longer isolate for MRSA. 130
Reposted by Brad SpellbergUSC/LA General ID Fellowship Program @lageneral-id.bsky.social · 22/12/2025Behind the scenes 🔥🔥 with all the laughs on the latest Febrile Podcast @febrilepodcast.com with @lageneral-id.bsky.social and @bradspellberg.bsky.social #IDSky player.captivate.fm/episode/dd68... 063
Brad Spellberg @bradspellberg.bsky.social · 13/12/2025No the patients got variable days of IV. But no relationship between number of days of IV prior to oral fosfo and outcomes. 000
Brad Spellberg @bradspellberg.bsky.social · 13/12/2025Not for me, no. I’d want source control of course. 010
Brad Spellberg @bradspellberg.bsky.social · 12/12/2025Yes there are 2 published observational studies. 1 from our group. Both were cUTI but both had bacteremia it’s described. 200
Reposted by Brad SpellbergInfected Terran @infectedterran.bsky.social · 10/12/2025Highly recommend you check out @bradspellberg.bsky.social book "Broken, bankrupt and dying". Achieving universal coverage can be done in many different ways. The rest of the developed world has done it in all different ways (government coverage, private/public, state subsidized etc). 0101
Brad Spellberg @bradspellberg.bsky.social · 08/12/2025Hasn't been much discussion of the 40% failure rate to fill ID programs this match year. Interesting. Wonder if anyone is ever going to do anything about that? 051
Reposted by Brad SpellbergAntibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 03/12/2025🆕🎙️🔥Febrile Podcast just dropped! ✅ID Jedi @bradspellberg.bsky.social ✅Mini-cases OM,IE,Bacteremia ✅IV vs PO debates ✅Duration of therapy ✅Shmidelines Vs WikiGuideline ✅A must-listen for every antibiotic steward! #IDsky #EMIMCC febrilepodcast.com/episodes/ open.spotify.com/episode/6dkJ... 082
Brad Spellberg @bradspellberg.bsky.social · 01/12/2025Full blown dementia with psychosis can be quite entertaining when Im off my meds. Have a listen! 250
Reposted by Brad SpellbergFebrile @febrilepodcast.com · 01/12/2025New episode out today: Listen in to this team from LA as they walk through several mini-cases and chat IV vs PO antibiotics! Feat: Fourth year medical student Hannah Chute, Dr. Paloma Reta-Impey, and @bradspellberg.bsky.social Also check out: www.bradspellberg.com/oral-antibio... #IDsky #MedSky 2114
Reposted by Brad SpellbergAntibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 19/11/2025🆕🔥🦴 Our 2025 Update to @wiki-guidelines.bsky.social for the Management of Pyogenic Osteomyelitis in Adults 🌟 @bradspellberg.bsky.social 🔗 [link] #idsky www.amjmed.com/article/S000... 02211
Brad Spellberg @bradspellberg.bsky.social · 18/11/2025Thrilled that another regulatory innovation out of LA General is now out in @jamanetworkopen.com! The first hospital in California authorized by CDPH to administer outpt hemodialysis for up to 2 weeks for inpatients newly started on HD who lack insurance. jamanetwork.com/journals/jam...jamanetwork.comHospital Hemodialysis Unit Flexibility and Hospital Length of StayThis quality improvement study evaluates the association of hospital length of stay with a first-in-state model in which an inpatient hemodialysis unit received regulatory approval to provide temporar... 081
Brad Spellberg @bradspellberg.bsky.social · 07/11/2025No but what I’m saying is, many patients get vanco who don’t have meningitis at all. They get the vanco before the LP, and the LP is negative for meningitis. So the denominator is all LPs done to evaluate for meningitis including those that are negative. 100
Brad Spellberg @bradspellberg.bsky.social · 07/11/2025Yes, we recommend adding vanco only for purulent meningitis, AFTER LP. One thing, there is no way 9% of LPs are S. pneumo. 9% of meningitis maybe. But vanco goes in before LP, so all those non meningitis LPs still got vanco and aren't counted in your calculations. I htink it's more lik 1 in 100 LPs. 100
Brad Spellberg @bradspellberg.bsky.social · 05/11/2025If 1% of ED LPs end up being for Pneumo, and 1% of Pneumo in adults is R, you will do 10,000 vanco courses for every 1 patient with CTX-R pneumococcal meningitis. That will definitely cause a large amount of AKIs and VREs. In LA, we recommend NOT adding vanco until LP CSF WBC/% PMN known. 292
Brad Spellberg @bradspellberg.bsky.social · 05/11/2025Yup, posted on the other platform. For PK, 2 gm CTX Cmax blood 250 mcg/ml, 10% CSF = 25 at peak. 4-6 hr half life: T0 = 25 T4 = 12.5 T8 = 6.25 T12 = 3.125 --should be above MIC whole interval. As far as the massive overuse of vanco, does depend on geography. In much of US, CTX-R rare in adults... 151
Reposted by Brad Spellbergwiki-guidelines.bsky.social @wiki-guidelines.bsky.social · 03/11/2025📢📢📢 We are delighted to announce that we are assembling team for our next project, Pharyngitis WikiGuideline Join us to create guidelines with the humility of uncertainty. Deadline to sign up is November 21, 2025. 152
Brad Spellberg @bradspellberg.bsky.social · 17/10/2025If we know it’s pneumococcus i do not use a second agent. The beta lactam is adequate. I do not find the theory of “anti inflammatory” benefit compelling or useful. Now, we could consider steroids for severe cap. 260
Brad Spellberg @bradspellberg.bsky.social · 01/10/2025People told me it was too radical at my place too. But then we walked everyone through the policy, which was developed with Counsel and Risk input. It is an actual structured policy that creates a due process mechanism for doing the right thing. It turns out to be rational, rather than radical. 110
Brad Spellberg @bradspellberg.bsky.social · 01/10/2025The main take away is to implement a Policy to Override Policies at your institutions too. 110
Brad Spellberg @bradspellberg.bsky.social · 05/09/2025Yeah but you’re Lawful Good. That’s ok. We need Lawful people too. It’s all about balance, right? 110
Brad Spellberg @bradspellberg.bsky.social · 05/09/2025Thanks to @abimfoundation.bsky.social ation for posting the video of my recent lecture on the LA General Policy to Override Policies. For those of you who know my lectures, this one is among the most entertaining. And it's only 10 min. Check it out & implement the policy! youtu.be/RuKAKH8A604?...youtu.beAdministrator/Clinician Collaboration: Policies to Put Patients FirstYouTube video by ABIM Foundation 173
Reposted by Brad SpellbergJames Wilson, DO, FACP, FAWM, CTropMed @jameswilsondo.bsky.social · 22/08/2025Another plug for #wikiguidelines @bradspellberg.bsky.social When guidelines don’t keep up with medicine 062
Brad Spellberg @bradspellberg.bsky.social · 14/08/2025I was thinking Samuel Clemens. “…lies, damn lies, and statistics.” 110
