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Julian Ventres, PharmD BCPS

@jjventres.bsky.social
2.3K followers 2.3K following 122 posts

Clinical pharmacist interested in infectious disease, antimicrobial resistance, and optimizing PK/PD targets Also an avid birder and photographer

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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 28/03/2026
These are all the ones I have, but definitely interested if anyone else has others 👀
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 11/12/2025
Treatment options for recurrent NDM-Pseudomonas bacteremia 2/2 UTI? Resistant to all the normal things. Previously treated with cefiderocol with MIC of 4, colistin MIC of 2. Aztreonam/avibactam an option here? Any luck getting FEP + taniborbactam or nacubactam? #IDSky
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 23/11/2025
*3-5 days for inpatient 😉 www.thelancet.com/article/S014...
thelancet.com
Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial
Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment. These ...
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 27/10/2025
Haven't been to Delaware but I can attest to the heat/humidity of the DC/Maryland area 🥵. Definitely feels like a breeding ground for Pseudomonas if every there was one
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 27/10/2025
I do personally use ceftriaxone for that reason, I do know some people hate 3rd gen cephs due to the CDI rates though so included Unasyn as an alternative. But agree ceftriaxone is the better empiric option
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 27/10/2025
Anti-Pseudomonal coverage for DFI is way overdone anyway. Ceftriaxone or Unasyn is sufficient for the majority of patients imo, +/- vanc.
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 25/10/2025
Two weeks late with this point, but was reading through 2011 IDSA MRSA guidelines which give the same level of recommendation (B-II) for both linezolid and vanc for the treatment of MRSA CNS infections www.idsociety.org/practice-gui...
idsociety.org
MRSA
Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of Ameri...
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Reposted by Julian Ventres, PharmD BCPS
Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 19/10/2025
🆕🔥🔥CloCeBa RCT Cloxacillin versus cefazolin for MSSA Bacteraemia Cefazolin has a non-inferior efficacy regarding mortality, microbiological or clinical endpoints and was associated with a lower rate of serious adverse events #IDSky www.thelancet.com/journals/lan...
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 16/10/2025
Vancomycin may be more studied but not sure about more reliable, especially in the CNS. LZD has great CNS penetration (>70-90%) whereas vanc's is somewhat limited by its large size. This is alleviated by inflammation in the acute phase but LZD still has better serum:csf concentrations overall
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 11/10/2025
Nothing drives me crazy like amox/clav or amp/sulbactam for strep or enterococcus
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 07/10/2025
Caveat: some meds are designed with certain pharmacokinetic goals in mind. Aminoglycosides, for example generally work better with higher peak concentrations, so splitting the dose up is counterproductive despite achieving a smoother concentration
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 06/08/2025
No, this isn't doing anything for the patient. I'm also not sure what they mean by "chronic" MRSA. If they have an active infection with those resistances, you would still have linezolid and tetracycline among other less common options. Oral vanc is just wiping out their GI flora
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 29/07/2025
Would love to see this be a regular thing, I wasn't active during what people have called the golden days of ID Twitter so would thrilled to have a regular journal club in #IDSky
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 28/07/2025
Agree, gentamicin is almost certainly still fine for Pseudomonas limited to the lower urinary tract. Systemic infections maybe not as much. Several other examples of situations where urinary concentrations overcome resistances, my favorite being using amox/amp for amp-resistant Enterococcus cystitis
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Reposted by Julian Ventres, PharmD BCPS
josh farkas 💊 @pulmcrit.bsky.social · 24/07/2025
we're under-utilizing aminoglycosides for urosepsis in patients with good renal function rising % ESBL is pushing us to use carbapenems for empiric therapy... leading to more resistance (CDiff, CRE) aminoglycosides have minimal gut penetration = low CDiff risk & protect microbiome 🧵 #1/4 #EMIMCC
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 25/07/2025
I do as well, assuming no uncontrolled source of infection (ie retained stone). Haven't noticed any issues. I try to use TMP/SMX or FQ if able but our E. coli is only ~70% susceptible to those, so using a lot of Amox/clav, less frequently cephalexin or cefpodoxime, and sometimes even just plain amox
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 23/07/2025
Wouldn't be my first choice certainly but I don't have a reason not to think it would work 🤷‍♂️
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 04/07/2025
Is just delaying it enough? Would you like severe, potentially life threatening diarrhea in 2 weeks or 6? We really need better treatment and prevention for CDI #IDSky #Medsky
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 19/06/2025
Bactrim will still be our first line for most things, but unfortunately our MRSA tetracycline susceptibilities are ~70% and dropping (clindas even worse). Will definitely have to keep in mind the toxicity aspect and awareness among our non-ID docs, thanks!
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 19/06/2025
Looking for people that have unrestricted linezolid at their institutions. Any increases in resistance? Better to just ease up on use criteria? Currently reviewing our own usage and seeing what we can do with rising tetracycline resistance in S. aureus #IDSky #AMSky
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 30/05/2025
Linezolid for odontogenic infections? Anyone doing this empirically? It feels like the data is there that LZD covers the relevant bugs, but there's no clinical data that I could find. Have to think LZD would be preferable to clinda #IDSky #AMSky
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 29/05/2025
Oral penem's make me real nervous 😬 not just from a therapeutic standpoint, but from a resistance perspective, being available outpatient for anyone to prescribe. Really think we need to do a better job of leveraging PK/PD to use existing agents when possible #IDSky #AMSSky
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Reposted by Julian Ventres, PharmD BCPS
Contagion® @contagionlive.bsky.social · 20/05/2025
Innoviva Specialty Therapeutics’ antibiotic is the first and only FDA-approved cephalosporin indicated to treat Staphylococcus aureus bacteremia, including right-sided endocarditis, caused by the methicillin-resistant Staphylococcus aureus. #IDsky #Medsky
contagionlive.com
Ceftobiprole Launches Commercially in US
Innoviva Specialty Therapeutics’ antibiotic is the first and only FDA-approved cephalosporin indicated to treat Staphylococcus aureus bacteremia (SAB), including right-sided endocarditis, caused by th...
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 18/05/2025
📌
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 13/05/2025
Would love to see what others use 👀 I have a personal one I use for unnecessary anaerobic coverage in aspiration pneumonia since it comes up frequently, although less and less
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 06/05/2025
📌
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Reposted by Julian Ventres, PharmD BCPS
BITSCOPIC @bitscopic.bsky.social · 05/05/2025
Derived from the PEN-FAST allergy decision tool, the CEPH-FAST version was developed and validated in this study. www.journalofinfection.com/article/S016...   #IDsky #pharmsky
journalofinfection.com
Development and Validation of a Cephalosporin Allergy Clinical Decision Rule
Utilising the previously published and internationally validated tool PEN-FAST, we validated the same criteria with minor modifications for low-risk cephalosporin allergies. The results suggest that a...
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 05/05/2025
📌
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 02/05/2025
I also hate the term "broad". What is "broad" antibiotics? TMP/SMX is exceptionally broad imo, but I don't see people using that when they're saying broad coverage. Same goes for doxy and mino. More often than not it just means they're throwing stewardship to the wayside during empiric coverage
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 24/04/2025
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 17/04/2025
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Reposted by Julian Ventres, PharmD BCPS
Erin McCreary, PharmD @erinmccreary.bsky.social · 12/04/2025
@steventong.bsky.social presents the results of the PSSA domain of the SNAP 🫰 trial - the worlds largest trial of staph aureus bacteremia - at #ESCMID2025 fluclox resulted in higher mortality and more AKI compared to penicillin for PSSA
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 11/04/2025
Personally I still don't feel comfortable using mino or doxy for Tet-R, but have done it on occasion when there wasn't any other reasonable option. Bactrim performs much better on our antibiogram, and can usually swap to linezolid otherwise
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 11/04/2025
We had this discussion recently at my institution. Tetracycline only covered ~65% of our MRSA. We looked at some resistance databases to see what percent of Tet-R we could expect to be doxy or mino-S, only improved to like 75%ish. In the end we moved tetracycline to 2nd line for SSTI.
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 28/03/2025
Not something I'm personally familiar with or read up on, but a quick search did bring up this paper which doesn't look promising for clinda. doi: 10.1093/clinids/23.4.718. PMID: 8909833.
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Reposted by Julian Ventres, PharmD BCPS
Bug Pharmacist // Tim Gauthier @idstewardship.bsky.social · 26/03/2025
📝Here are my cliff notes for the recently FDA approved drug #gepotidacin #blujepa www.idstewardship.com/drugs/gepoti... 🤔 Still wondering where the name comes from? It’s a yellow tablet… Kind of sounds like Jet Blue 🤷‍♂️ Anything to add? #IDsky
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 09/03/2025
☝️I think this is the better thing to focus on. No need to argue which regimen is better if no antibiotics is the appropriate regimen.
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 09/03/2025
Pip/taz is one of our limited options for Pseudomonas however, and so we should try to reserve it for Pseudomonas because losing it's effectiveness knocks out a comparatively larger part of our armamentarium for that bacteria
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 09/03/2025
I think more important than spectrum is their role in current treatment. We use things like doxycycline and Bactrim constantly, despite them objectively very broad. But the things we use them for have plenty of options, and so losing Bactrim or doxy susceptibility isn't as big a problem.
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 08/03/2025
If your institution has a Clinical Decision Unit for intermediate patients who may or may not need inpatient care, do they primarily use IV or PO antibiotics? Trying to push for more PO in this setting but also trying to anticipate challenges #IDSky #Pharmsky
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 03/03/2025
Good to know, not sure how to incorporate into practice though 🤔 I guess in someone failing fidaxomicin can still consider vancomycin, but the high baseline recurrence rate muddies the picture certainly
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 27/02/2025
Synergistic blockage of the hERG potassium channel is the proposed mechanism pmc.ncbi.nlm.nih.gov/articles/PMC....
pmc.ncbi.nlm.nih.gov
Ceftriaxone and the Risk of Ventricular Arrhythmia, Cardiac Arrest, and Death Among Patients Receiving Lansoprazole
In adult medical inpatients receiving ceftriaxone treatment, is concomitant lansoprazole compared with other proton pump inhibitors associated with increased risk of ventricular arrhythmia or cardiac ...
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 27/02/2025
I haven't personally at our institution, however have gotten the same advisory from RI DOH. Wonder if the fluid shortage and more IV push may have something to do with it as well
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 26/02/2025
There is actually some evidence behind this (only in combo therapy with lansoprazole to the best of my knowledge), although I agree it's unlikely as the primary cause for most cases www.journalofinfection.com/article/S016...
journalofinfection.com
Concomitant use of lansoprazole and ceftriaxone is associated with an increased risk of ventricular arrhythmias and cardiac arrest in a large Japanese hospital database
To determine whether concomitant use of ceftriaxone and oral or intravenous lansoprazole increases the risk of ventricular arrhythmia and cardiac arrest in the real-world setting in Japan.
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 25/02/2025
Maybe if we're lucky the software will recommend firing DOGE
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 24/02/2025
And actually, I should say no differences in efficacy specifically. There were differences; IV regimen associated with more adverse effects.
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 24/02/2025
Heldman et al. 1996 doi: 10.1016/S0002-9343(96)00070-8. One of my favorites, although the regimen used isn't really relevant anymore. Oral cipro+rifampin upfront versus vanc+oxacillin for Staph endocarditis. If we could use this regimen as empiric therapy, oral transition is totally fine in my book
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 24/02/2025
Even for complicated, there is data supporting orals. Heldman et al. 1996 is one of my favorites, randomized to oral cipro+rifampin versus vanc+oxacillin for Staph endocarditis. No differences found. Obviously resistance rates have changed but still shows that the route of admin is not important
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Reposted by Julian Ventres, PharmD BCPS
Betsy Hirsch, PharmD (TLOAS) @ebhirsch.bsky.social · 20/02/2025
‼️The @idsainfo.bsky.social cUTI guideline 📄 draft is now available for public comment🗣️! This version has been reviewed by 15+ orgs & revised according to extensive feedback provided to us. www.idsociety.org/practice-gui... UTIsky IDsky Medsky PharmSky
Screenshot of IDSA cUTI guideline open for public commentDraft of IDSA cUTI guideline showing steps to follow for selection of therapy Figure 2 flowchart showing stepwise assessment of IV to PO switch and duration of therapyFigure showing old vs new definition of uUTI, cUTi, and acute pyelonephritis
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Julian Ventres, PharmD BCPS @jjventres.bsky.social · 20/02/2025
Thrilled to finally have guidelines stating that not all male UTIs are complicated. Lots of other good things in here too, but that ones probably my biggest pet peeve 🎉
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