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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 04/08/2026

This doesn’t change my practice. Been encouraging tapers for any (including first) recurrence. Gotta be a special kind of nuts to consider giving someone on their 2nd recurrence a fixed course of anything.

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 27/07/2026

Wonder what the cost difference will be between the US and Thailand

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 07/07/2026

Stewardship of urine testing and treatment is a great use of nursing colleagues

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 24/06/2026

Proud to have shaped our ASP in this spirit and proud our team got this one to the finish line. We all do better when we all do better! ✨ #IDSky

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 24/06/2026

PAF really isn't the "end all be all." In fact, I think it decreases health equity as compared to other upstream interventions and creates a self fulfilling prophecy. Turns out empowering non-ID clinicians to do PAF creates a culture of shared responsibility + expands access to ID expertise. #IDSky

cambridge.org

Exploring unconventional antimicrobial stewardship models: options beyond traditional prospective audit and feedback | Infection Control & Hospital Epidemiology | Cambridge Core

Exploring unconventional antimicrobial stewardship models: options beyond traditional prospective audit and feedback

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 18/06/2026

Painting the peacock with fancy stats. There is equipoise for sure. Not convinced though. Classic synergy is a test tube concept not yet shown to be beneficial to meaningful outcomes in real Homo sapiens.

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 18/06/2026

SNAP has a dapto with cefazolin combination arm in the MRSA silo

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Reposted by Zack (Snacks) Nelson, PharmD, MPH

Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 30/05/2026

This is exactly why in our UTI WikiGuideline we advocate abandoning vague adjectives to describe infections that mean different things to different people

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 30/05/2026

This is exactly why in our UTI WikiGuideline we advocate abandoning vague adjectives to describe infections that mean different things to different people

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 21/05/2026

Why do we keep disrupting the microbiome because we find bacteria where bacteria live and expecting some loosely associated condition to magically get better by killing said bacteria?

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Reposted by Zack (Snacks) Nelson, PharmD, MPH

Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 06/05/2026

This dogma must stop being taught to clinicians and be put out to pasture as a relic of a bygone era in scientific literature. I love this 😍 What other dogmas should we retire? #idsky #microsky #EMIMCC

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 24/04/2026

Linezolid is perhaps one of the best anti Staph pneumonia and skin agents we have. It may be better if the bacteremia originated from those sources but probably not because of antitoxin effects in this setting

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 24/04/2026

Yes, we’re basically one step past blood letting and tincture of poppy

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 20/04/2026

How many were not E. coli or E. faecalis?

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 15/04/2026

Would love to connect on this work! I can't send you a message, but if you can DM me, can provide email :)

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 13/04/2026

I’m not sold. “Target trial emulation” = fancy way of saying “retrospective observational”

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 10/04/2026

I never underestimate the power of fear to cause bad decisions.

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 10/04/2026

I can't imagine why. This is a well documented training method per Pavlov, et al ;)

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 10/04/2026

But we are getting lots of pushback from ED. All other departments are fine with this. I think there are things that are just not being said (e.g., convenient when no other dx is apparent, can then do something and get a good review) as opposed to just "prescribing" watchful waiting. Thank you!

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 10/04/2026

We considered the UA only for patients without classic symptoms, but feel like this still influences clinician decision making (e.g., treating ASB), so the hope was to not have a selectable option that would encompass patients with AMS/weakness/confusion without systemic symptoms.

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 10/04/2026

Does anyone have formalized EMR interventions/protocols that have made it more difficult for certain care settings (ED) to order urine testing based on cloudiness/darkness of urine, altered mental status without systemic symptoms, etc. and are willing to share screenshots? #IDSky #MedSky

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 05/04/2026

Has anyone else seen this with omadacycline? I have once. #IDSky

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 28/03/2026

Untreated chlamydia has different implications than carriage of GAS, etc. in my opinion.

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 28/03/2026

Well according to PROSTASHORT, a dose of oflox equal to 100 mg BID of levo treats febrile UTI (clinical cure 96%, 7 day duration). So yes!

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 28/03/2026

And preferably not just criss crossed E-tests!

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 27/03/2026

Considering a large proportion of chlamydia cases are asymptomatic, hard not to screen right? Chlamydia infection increases risk for HIV acquisition, maybe prostatitis other issues you have already mentioned. Maybe it’s moot in the era of PrEP, but not sure how abundant daily adherence to it is.

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 18/03/2026

They also cherry picked data and said firmly that doxycycline should be avoided. Bad. #IDSky

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 16/03/2026

Perplexing that this made it through peer review without mention of an entire guideline published in the last 1.5 years directly relevant to the content… 🤔 #IDSky

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Reposted by Zack (Snacks) Nelson, PharmD, MPH

Prof Jenny Rohn @jennyrohn.bsky.social · 11/03/2026

What a study - nearly 15,000 people followed up 4-8 years after a *sole* antibiotic treatment and some *still* had disrupted gut microbiome diversity. Pretty incredible. We’ve always been taught that such disruptions are ephemeral. #IDSky #MicroSky

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 11/03/2026

We use cefazolin plus metronidazole in most situations where cefoxitin was historically used. (3 g for >120 kg)

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 09/03/2026

How fun! Don't know of any lit, but back-of-napkin math seems consistent with your findings & may support longer intervals especially in cases of severe renal impairment and exquisitely susceptible organisms. Suspect combo of in vitro concepts/no concerns of PTA led to minimal exploration of this?

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 09/03/2026

@dremilymcd.bsky.social is a wealth of knowledge as she sits on the steering committee and has led a guideline publication. I led the UTI effort published in November 2024. Let me know how we can be helpful!

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Zack (Snacks) Nelson, PharmD, MPH @zacrobid.bsky.social · 08/03/2026

Enjoyed the discussion but disappointed that WikiGuidelines, which importantly addresses many of the shortcomings highlighted, was not even mentioned 🤔 #IDSky #MedSky @erinmccreary.bsky.social @cmicomms.bsky.social @angelahuttner.bsky.social

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