Podcasts about cephalosporins

Free book is here at https://www.memorizingpharm.com/books In this episode we return to turning the open educational nursing resource for nursing pharmacology into audio, we'll start with the 1st edition antimicrobials then move on to the new second edition with the next topic.  Summary 3.6 Cephalosporins Nursing Pharmacology  Chapter 3.6 of the Nursing Pharmacology guide focuses on cephalosporins, a class of antibiotics similar to penicillins. The chapter covers their mechanism (cell wall disruption), indications (skin, bone, respiratory infections), different generations with expanding spectra, and administration considerations. It also highlights monitoring for allergies, renal impairment, and possible disulfiram-like reactions with alcohol. Patient education emphasizes avoiding alcohol and reporting signs of superinfection. Multiple Choice Questions Cephalosporins work primarily by: a) Inhibiting protein synthesis b) Disrupting cell wall synthesis c) Altering DNA replication d) Blocking RNA transcription Which generation of cephalosporins is effective against MRSA? a) 1st generation b) 2nd generation c) 4th generation d) 5th generation What side effect may occur when consuming alcohol with cephalosporins? a) Increased appetite b) Hair loss c) Disulfiram-like reaction d) Drowsiness Patients with allergies to penicillin might also react to: a) Cephalosporins b) Tetracyclines c) Aminoglycosides d) Fluoroquinolones What should be monitored when administering cephalosporins to a patient with renal impairment? a) Blood pressure b) Liver enzymes c) Blood urea nitrogen (BUN) and creatinine d) Heart rate Answer Key b) Disrupting cell wall synthesis d) 5th generation c) Disulfiram-like reaction a) Cephalosporins c) Blood urea nitrogen (BUN) and creatinine ```

In this episode, we discuss current evidence about potential cross-reactivity for patients with penicillin allergy who receive a cephalosporin. Then we discuss the safety of antidepressant medications in pregnancy. 

In this episode, we review the high-yield topic of Cephalosporins ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Microbiology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

Dr. Kimberly Blumenthal (@KimberlyBlumen1), Dr. Meghan Jeffres (@PharmerMeg), and Dr. Eric Macy (@EricMacyMD) join Dr. Julie Ann Justo (@julie_justo) to summarize the history of cephalosporin avoidance in penicillin allergies, evidence-based pros and cons of giving cephalosporins in penicillin allergy, how to leverage technology to improve treatment of patients with penicillin allergies, and much more! Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References Macy E. Why Was There Ever a Warning Not to Use Cephalosporins in the Setting of a Penicillin "Allergy"? J Allergy Clin Immunol Pract. 2021 Nov;9(11):3929-3933. doi: 10.1016/j.jaip.2021.06.059. PMID: 34303019. Liang EH, et al. Adverse Reactions Associated with Penicillins, Carbapenems, Monobactams, and Clindamycin: A Retrospective Population-based Study. J Allergy Clin Immunol Pract. 2020 Apr;8(4):1302-1313.e2. doi: 10.1016/j.jaip.2019.11.035. PMID: 31821919. Macy E, Contreras R. Adverse reactions associated with oral and parenteral use of cephalosporins: A retrospective population-based analysis. J Allergy Clin Immunol. 2015 Mar;135(3):745-52.e5. doi: 10.1016/j.jaci.2014.07.062. PMID: 25262461. Macy E, et al. Population-Based Incidence of New Ampicillin, Cephalexin, Cefaclor, and Sulfonamide Antibiotic "Allergies" in Exposed Individuals with and without Preexisting Ampicillin, Cephalexin, or Cefaclor "Allergies". J Allergy Clin Immunol Pract. 2022 Feb;10(2):550-555. doi: 10.1016/j.jaip.2021.10.043. PMID: 34757066. Picard M, et al. Cross-Reactivity to Cephalosporins and Carbapenems in Penicillin-Allergic Patients: Two Systematic Reviews and Meta-Analyses. J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2722-2738.e5. doi: 10.1016/j.jaip.2019.05.038. PMID: 31170539. Romano A, et al. Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell-mediated hypersensitivity to penicillins. J Allergy Clin Immunol. 2016 Jul;138(1):179-186. doi: 10.1016/j.jaci.2016.01.025. PMID: 27016799. Romano A, et al. Cross-Reactivity and Tolerability of Cephalosporins in Patients with IgE-Mediated Hypersensitivity to Penicillins. J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1662-1672. doi: 10.1016/j.jaip.2018.01.020. PMID: 29408440. Blumenthal KG, et al. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk. Clin Infect Dis. 2018 Jan 18;66(3):329-336. doi: 10.1093/cid/cix794. PMID: 29361015. Blumenthal KG, et al. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ. 2018 Jun 27;361:k2400. doi: 10.1136/bmj.k2400. PMID: 29950489. Blumenthal KG, et al. Recorded Penicillin Allergy and Risk of Mortality: a Population-Based Matched Cohort Study. J Gen Intern Med. 2019 Sep;34(9):1685-1687. doi: 10.1007/s11606-019-04991-y. PMID: 31011962. Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: A cohort study. J Allergy Clin Immunol. 2014 Mar;133(3):790-6. doi: 10.1016/j.jaci.2013.09.021. PMID: 24188976. AAAI. Choosing Wisely. 2014 Mar 3. https://www.choosingwisely.org/clinician-lists/american-academy-allergy-asthma-immunlogy-non-beta-lactam-antibiotics-penicillin-allergy/ Jeffres MN, et al. Systematic review of professional liability when prescribing β-lactams for patients with a known penicillin allergy. Ann Allergy Asthma Immunol. 2018 Nov;121(5):530-536. doi: 10.1016/j.anai.2018.03.010. PMID: 29551402. Macy E, et al. Association Between Removal of a Warning Against Cephalosporin Use in Patients With Penicillin Allergy and Antibiotic Prescribing. JAMA Netw Open. 2021 Apr 1;4(4):e218367. doi: 10.1001/jamanetworkopen.2021.8367. PMID: 33914051. Blumenthal KG, et al. Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation. J Allergy Clin Immunol Pract. 2017 May-Jun;5(3):616-625.e7. doi: 10.1016/j.jaip.2017.02.019. PMID: 28483315. Jeffres M. Penicillin and/or Beta-Lactam Allergy Tip Sheet & Cross-reactivity Table. https://drive.google.com/file/d/1cokYXnSDlO3vk8ke1LaalPz4iavuNSV8/view?usp=share_link Khan DA, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. 2022 Sep 17:S0091-6749(22)01186-1. doi: 10.1016/j.jaci.2022.08.028. Epub ahead of print. PMID: 36122788. Guyer AC, et al. Allergy Electronic Health Record Documentation: A 2022 Work Group Report of the AAAAI Adverse Reactions to Drugs, Biologicals, and Latex Committee. J Allergy Clin Immunol Pract. 2022 Nov;10(11):2854-2867. doi: 10.1016/j.jaip.2022.08.020. PMID: 36151034. Iammatteo M, et al. Safety and Outcomes of Oral Graded Challenges to Amoxicillin without Prior Skin Testing. J Allergy Clin Immunol Pract. 2019 Jan;7(1):236-243. doi: 10.1016/j.jaip.2018.05.008. PMID: 29802906. Bavbek S, et al. Determinants of nocebo effect during oral drug provocation tests. Allergol Immunopathol (Madr). 2015 Jul-Aug;43(4):339-45. doi: 10.1016/j.aller.2014.04.008. PMID: 25088674. DePestel DD, et al. Cephalosporin use in treatment of patients with penicillin allergies. J Am Pharm Assoc (2003). 2008 Jul-Aug;48(4):530-40. doi: 10.1331/JAPhA.2008.07006. PMID: 18653431. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. 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The development of penicillin started – but definitely did not end – with the chance discovery of some mold in a petri dish. There is so much more to the story. Research: Bernard, Diane. “How a miracle drug changed the fight against infection during World War II.” Washington Post. 7/11/2020. https://www.washingtonpost.com/history/2020/07/11/penicillin-coronavirus-florey-wwii-infection/ British Library. “Inventor(s) of the month, Alexander Fleming and the story of Penicillin.” 7/28/2021. https://blogs.bl.uk/business/2021/07/inventors-of-the-month-alexander-fleming.html Chain, E. et al. “Penicillin as a Chemotherapeutic Agent.” The Lancet. Vol. 236, Issue 6104. 8/24/1940. https://doi.org/10.1016/S0140-6736(01)08728-1 Fleming A. On the Antibacterial Action of Cultures of a Penicillium, with Special Reference to their Use in the Isolation of B. influenzæ. Br J Exp Pathol. 1929 Jun;10(3):226–36. PMCID: PMC2048009. Gaynes, Robert. “The Discovery of Penicillin—New Insights After More Than 75 Years of Clinical Use.” Emerg Infect Dis. 2017 May; 23(5): 849–853.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403050/ Lee, Victoria. “Microbial Transformations.” Historical Studies in the Natural Sciences, SEPTEMBER 2018, Vol. 48, No. 4. Via JSTOR. https://www.jstor.org/stable/10.2307/26507225 National Museums of Scotland. “Culture Vessel.” https://www.nms.ac.uk/explore-our-collections/stories/science-and-technology/culture-vessel/ Quinn, Roswell. “Rethinking Antibiotic Research and Development: World War II and the Penicillin Collaborative.” American Journal of Public Health | March 2013, Vol 103, No. 3. Scibilia, Anthony Julius. “Being Prometheus in 1943:: Bringing Penicillin to the Working Man.” Pennsylvania History: A Journal of Mid-Atlantic Studies , Vol. 80, No. 3 (Summer 2013). https://www.jstor.org/stable/10.5325/pennhistory.80.3.0442 Science History. “Alexander Fleming.” 12/5/2017. https://www.sciencehistory.org/historical-profile/alexander-fleming Science Museum. “How Was Penicillin Developed?” 2/23/2021. https://www.sciencemuseum.org.uk/objects-and-stories/how-was-penicillin-developed Shama, Gilbert. “'Déjà Vu' – The Recycling of Penicillin in Post-liberation Paris.” Pharmacy in History , 2013, Vol. 55, No. 1 (2013). Via JSTOR. https://www.jstor.org/stable/23645718 The Alexander Fleming Laboratory Museum, London, UK. “The Discovery and Development of Penicillin 1928-1945.” 11/19/1999. https://www.acs.org/content/dam/acsorg/education/whatischemistry/landmarks/flemingpenicillin/the-discovery-and-development-of-penicillin-commemorative-booklet.pdf Wainwright, Milton. “Moulds in Folk Medicine.” Folklore , 1989, Vol. 100, No. 2 (1989). https://www.jstor.org/stable/1260294 Wainwright, Milton. “The History of the Therapeutic Use of Crude Penicillin.” Medical History, 1987, 31: 41-50. Williams KJ. The introduction of 'chemotherapy' using arsphenamine - the first magic bullet. J R Soc Med. 2009 Aug;102(8):343-8. doi: 10.1258/jrsm.2009.09k036. PMID: 19679737; PMCID: PMC2726818. Wood, Jonathan. “Penicillin: The Oxford Story.” Oxford News Blog. 7/16/2010. https://www.ox.ac.uk/news/science-blog/penicillin-oxford-story Zaffiri, Lorenzo et al. “History of Antibiotics. From Salvarsan to Cephalosporins.” Journal of Investigative Surgery, 25, 67–77, 2012.  See omnystudio.com/listener for privacy information.

Callum and Jame provide an overview of the Cephalosporin class of antibiotics, discussing mechanism of action, spectrum, classification, PK/PD, side effects and some clinical uses.Send suggestions to idiotspodcasting@gmail.com

This episode features Dr. Travis Jones from DASON. The article reviewed in this episode is available here: https://doi.org/10.1016/j.ijantimicag.2022.106560. For more information about DASON, please visit: https://dason.medicine.duke.edu.

This episode covers cephalosporins!

This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD. Pediatric ID specialist Michael Neely, MD, and Michael Cosimini, MD discuss how cephalosporins work and which bugs they do and do not kill. Pearls: In general, cephalosporins do not cover anaerobes, enterococcus, listeria and MRSA. Oral cephalosporins are generally not first line in pediatrics.  Some exceptions include the treatment of UTIs and some skin and soft tissue infections; group A strep and sinopulmonary infections in penicillin allergic patients are other common indications. 1st generation cephalosporins do have gram positive coverage, but do not work well against strep pneumo, MRSA, enterococcus. They do cover some enteric gram negative bacteria, the “PECK” organisms.   What are cephalosporin antibiotics and how do they compare to penicillins?  Chemically, both penicillins and cephalosporins are beta-lactam antibiotics, with the beta-lactam portion responsible for bacterial killing.  The chemical portions off the beta-lactam ring make the antibiotics different. Beta-lactam antibiotics work by binding to the penicillin-binding protein on the bacterial cell wall.  These proteins have structural functions that maintain the integrity of the bacterial cell wall and therefore, when these antibiotics bind, the penicillin-binding protein is disrupted, the cell wall falls apart and the bacterial dies.       How do you keep a straight spectrum of activity for antibiotics?  To help with this, think of bacteria into big categories: gram-positive, gram-negative and “other”. Gram-positive bacteria include: Staph aureus (MSSA, MRSA), Streptococcus (Group A Strep, Group B Strep, Strep pyogenes, Strep viridans), Enterococcus, Pneumococcus, Listeria Gram-negative bacteria are a much bigger group and can be divided into: Respiratory gram-negatives include Moraxella, Haemophilus, Meningococcus Enteric gram-negatives include the “PECK” bacteria: Proteus, E.coli, Klebsiella What bacteria do cephalosporins not cover?  In general, cephalosporins do not cover anaerobic bacteria, enterococcus, listeria and MRSA.  There are a few exceptions to this rule. Cefoxitin (a second generation cephalosporin), for example, does have anaerobic coverage.  It is commonly used in the treatment of PID as it covers enteric anaerobes and Neisseria gonorrhea. There is a 5th generation cephalosporin that does cover MRSA (discussed later). Are cephalosporins well absorbed?  Generally speaking, cephalosporins in oral formulations are not as well absorbed as penicillins and are more difficult to get where they need to go outside the urinary tract. Also, generally speaking, no beta-lactam really gets into the spinal fluid in very high concentrations; all of them do have better penetration when there is inflammation.  Practically, remember that the penetration into the CSF between ampicillin and ceftriaxone is negligible. What bacteria do first generation cephalosporins cover?  Although the classic teaching is that cephalosporins are good for gram-positive coverage (staph and strep), this is not a hard and fast rule.  As stated, enterococcus is not covered by any cephalosporin and MRSA is not covered by most cephalosporins.  First generation cephalosporins are also good for coverage of the “PECK” enteric gram negative bacteria, but not good for coverage of other gram negative bacteria.  These organisms tend to cause UTIs and therefore, first generation cephalosporins (for example, cephalexin) are frequently used for UTI treatment. Of course, resistance can occur.    Even though strep pneumo is a gram-positive organism, when it comes to first generation cephalosporins, it acts like a gram-negative organism and therefore, first generation cephalosporins do not work well against strep pneumo.   What about bacteria that develop resistance?  A patient with an E. Coli UTI, for example, may have a microbiology laboratory report stating that the E. Coli is resistant to a first generation cephalosporin but the patient is still getting better.  This may have to do with the type of infection the patient had; for example, a healthy patient with a simple cystitis may have been able to stay well hydrated and the normal immune system was able to clear the E. Coli. This question can also be answered in the context of breakpoints, that is when the bacteria become susceptible or resistant to the antibiotic depending on the site of infection.  Some labs will actually label a bacteria resistant or susceptible depending on whether the infection is in the urine, spinal fluid or blood. Therefore, if a lab that reports site-specific breakpoints suggests that an E. Coli is resistant to a first generation cephalosporin in the urine, the lab has already taken into account the higher concentration of drug in the urine.  Similarly, a pneumococcal isolate that may be resistant to ceftriaxone in the CNS may be susceptible to ceftriaxone as a pneumonia because there are much higher concentrations of ceftriaxone in the lungs than in the spinal fluid. When should a skin or soft tissue infection be treated with a first-generation cephalosporin?  When should MRSA be suspected? This can be a tricky question as an outpatient, but there are some clues to gauge whether or not the infection may be caused by MRSA.   One, it is helpful to know the community prevalence of MRSA.  In some communities, community acquired staph aureus infections are up to 80-90% MRSA.  In these communities, MRSA coverage should of course be given. If the prevalence is much lower, using a first generation cephalosporin, such as cephalexin may be reasonable.   Other clues can be more specific to the patient the their families.  Is the patient or family known to be colonized with MRSA? Have they had an MRSA infection in the past? If MRSA coverage is needed, either trimethoprim-sulfa or clindamycin generally is a good approach.  A randomized controlled trial published in the NEJM showed no difference in outcomes when treating a known MRSA infection. Miller LG et al.  Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections.  N Engl J Med. 2015 Mar 19;372(12): 1093-103. https://www.ncbi.nlm.nih.gov/pubmed/25785967 In general, the quality of the infection does not help point to MRSA or not.  There is some suggestion that if there is a soft-tissue abscess this is more likely staph aureus and if there is just pure erythema, tenderness and warmth without abscess, this is more likely to be Group A strep.   Remember, no matter what antibiotic is started for cellulitis (or any infection, for that matter), follow up is essential.  If you are on the right antibiotics, cellulitis should be improving within 24 hours.

Este es Medical commons un podcast de la academia de atención Primaria para el mejoramiento de la calidad de la atención en salud de las Américas, a continuación intentaremos dar una revisión sistemática por los temas mayormente  preguntados en los exámenes de residencias médicas en Colombia y que frecuentemente son motivo de consulta en atención primaria.  Todas las decisiones médicas y recomendaciones aquí expresadas deben de ser comparadas con la información académica oficial y jamás deben de ser tomados como un absoluto, los actos médicos derivados de estos audios son responsabilidad de aquellos que ejercen. Usted puede ir a nuestro sitio web y dejar una donación para que juntos continuemos con esta actividad. Es esencial vigilar los posibles signos de reacción anafiláctica, así como reacciones alérgicas como urticaria, picazón e hinchazón. Los médicos y farmacéuticos también deben controlar la función renal periódicamente porque eso podría justificar un cambio en la dosis y / o frecuencia de dosificación de la cefalosporina (excepto ceftriaxona).  Con otras posibles reacciones adversas enumeradas anteriormente, controle el hemograma completo para detectar posibles signos de anemia hemolítica inmunitaria inducida por fármacos o hipoprotrombinemia por deficiencia de vitamina K. Además, controle los posibles signos de una reacción similar al disulfiram o colitis pseudomembranosa. .    Bui T, Preuss CV. Cephalosporins. [Updated 2020 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551517/   Este podcast se distribuye bajo los términos de Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), que permite su uso, duplicación, adaptación, distribución y reproducción en cualquier medio o formato, siempre que otorgue el crédito apropiado al autor o autores originales y la fuente, se proporciona un enlace a la licencia Creative Commons, y se indican los cambios realizados.

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More patients are being admitted to the hospital with skin problems, and specialized dermatologists are needed to provide effective treatment. Dr. Vincent DeLeo talks with Dr. Michi M. Shinohara about the evolving role of the dermatology hospitalist in the inpatient setting. Dr. Shinohara highlights some key takeaways about job satisfaction and barriers to care from a recent survey of members of the Society for Dermatology Hospitalists. We also bring you the latest dermatology news and research: 1. Cephalosporins remain empiric therapy for skin infections in pediatric atopic dermatitis “When a patient with AD walks into your office and looks like they have an infection of their eczema, your go-to antibiotic is going to be one that targets MSSA [methicillin‐sensitive Staphylococcus aureus].” 2. Should you market your aesthetic services to the ‘Me Me Me Generation’? By 2020, spending by millennials will account for $1.4 trillion in U.S. retail sales. Things you will learn in this episode: Inpatient care is getting increasingly complex, but dermatology has become more outpatient-centric overall: “There has really been a shift over time from dermatologists acting as the primary admitting service to more of a consulting service,” Dr. Shinohara explains. As a result, inpatient dermatology has become more specialized, leading to the development of the dermatology hospitalist. The Society for Dermatology Hospitalists was created in 2009 by a group of medical dermatologists to develop the highest standards of clinical care in hospitalized patients with skin disease. Most requests for inpatient dermatology consultations come from medical services for conditions commonly seen in an outpatient clinic. However, the hematology/oncology service is a common source of dermatology consultations, requiring a separate knowledge base. Dermatology hospitalists typically dedicate 25%-50% of their time on inpatient consultations. Time that dermatology hospitalists spend in the hospital is fundamentally different than time spent in clinic: “You have a lot more time to think about your patients and to teach about them to your trainees,” Dr. Shinohara notes. “It’s really one of the few places that I find you still have the opportunity to work as a team together.” Personal fulfillment is high among dermatology hospitalists, which can help combat burnout. A key challenge that dermatology hospitalists face is that most don’t generate the same revenue doing consultations as they do in clinic. Financial support from medical institutions and recognition of the value of the work is crucial to the longevity of dermatology hospitalists, who tend to be a younger workforce. Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Michi M. Shinohara, MD (University of Washington, Seattle) Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Background/Objectives: Antibiotic use in early life has been associated with weight gain in several populations. However, associations between chronic antibiotic use and weight among adults in the general population are unknown. Subjects/Methods: The NIEHS Sister Study is a longitudinal cohort of sisters of women with breast cancer. We examined associations between chronic antibiotic use (≥ 3 months) during the fourth decade of life (30–39 years) and subsequent obesity at enrollment (mean age = 55) via logistic regression. We also examined associations between chronic antibiotic use in the 5 years and 12 months prior to enrollment and weight gain after enrollment in linear mixed models. Models were adjusted for race/ethnicity, education, urban/rural status, age, and smoking. Results: In adjusted analyses (n = 50,237), chronic penicillin use during the 4th decade of life was associated with obesity at enrollment (OR 2.00, 95% CI 1.40, 2.87), and use in the 5 years prior to enrollment was associated with increased BMI change after enrollment (β 1.00 95% CI 0.01, 2.00). Use of bactericidals (OR 1.71, 95% CI 1.29, 2.26) during the 4th decade of life was also associated with obesity at enrollment. Associations for penicillins and bactericidals were consistent across indications for use. Bacteriostatic use in the 5 years prior to enrollment was associated with a reduction in BMI after enrollment (β -0.52, 95% CI -1.04, 0.00), and tetracycline use during the 4th decade of life was associated with reduced odds of obesity at enrollment (OR 0.72, 95% CI 0.56, 0.92). However, these inverse associations were only present for those who reported taking antibiotics for skin purposes. Cephalosporins, macrolides, quinolones, and sulfonamides were not associated with BMI change over time. Conclusions: Chronic use of antibiotics during adulthood may have long-lasting impacts on BMI. Associations may differ by antibiotic class, and confounding by indication may be important for some antibiotic classes. Furlong M, Deming-Halverson S, Sandler DP. Chronic antibiotic use during adulthood and weight change in the Sister Study. PLoS One. 2019;14(5):e0216959. Published 2019 May 16. doi:10.1371/journal.pone.0216959. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Sections of the Abstract and Introduction are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522121/

We investigate the claim that an alternative antibiotic to cephalosporins (e.g., cefazolin) should be selected for penicillin-allergic patients in the perioperative setting.  Claim 1. Alternative antibiotics may be as efficacious in preventing surgical site infections Claim 2. Cephalosporins (e.g., cefazolin) may be unsafe due to cross-reactivity.  Claim 3. Administering cephalosporins (e.g., cefazolin) may be against the standard of care. My guest this week is Dr. Matthew Vanneman, an attending cardiothoracic anesthesiologist at the Massachusetts General Hospital.  Full show notes available at depthofanesthesia.com.  Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Beltran RJ, Kako H, Chovanec T, Ramesh A, Bissonnette B, Tobias JD. Penicillin allergy and surgical prophylaxis: cephalo- sporin cross-reactivity risk in a pediatric tertiary care center. J Pediatr Surg. 2015;50:856–859. Blumenthal KG, Ryan EE, Li Y, Lee H, Kuhlen JL, Shenoy ES. The impact of a reported penicillin allergy on surgical site infec- tion risk. Clin Infect Dis. 2018;66:329–336. Blumenthal KG et al. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: Population based matched cohort study. BMJ 2018 Jun 27; 361:k2400.  Jeffres M, Hall-Lipsy E, King ST, Cleary J. Systematic Review of Professional Liability when Prescribing Β-Lactams for Patients with a Known Penicillin Allergy. Open Forum Infect Dis. 2017;4(Suppl 1):S341. Published 2017 Oct 4. doi:10.1093/ofid/ofx163.812 Macy E, Contreras R. Adverse reactions associated with oral and parenteral use of cephalosporins: a retrospective population-based analysis. J Allergy Clin Immunol 2015;135:745-752.e745. Petz LD. Immunologic reactions of humans to cephalosporins. Postgrad Med J. 1971;47:Suppl:64-9. Petz LD. Immunologic cross-reactivity between penicillins and cephalosporins: a review. J Infect Dis 1978;137:S74-9. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cepha- losporin antibiotics for penicillin-allergic patients. Pediatrics. 2005;115:1048–1057. Zagursky RJ, Pichichero ME. Cross-reactivity in β-lactam allergy. J Allergy Clin Immunol Pract. 2018;6:72–81.e1. --

Talk About: A continuation on beta lactam antibiotics, specifically cephalosporins. We break down their spectrum of activity, adverse effects, and drug of choice options for specific organisms. Also touched upon the cephalosporin which come in combination with a beta lactamase inhibitor.

In this podcast, Maddi and I discuss very commonly used classes of antibiotics in ICU i.e Penicillins and Cephalosporins.

Click Here To Buy Your BTK Shirt!   The Skeptical Scalpel joins Behind The Knife as we examine surgical dogma. Check out The Skeptical Scalpel at skepticalscalpel.blogspot.com or on Twitter at @SkepticScalpel     Sources for Mythbuster Episode   Bouffants vs Cloth Hats University of Buffalo Neurosurgery Study https://academic.oup.com/neurosurgery/article-abstract/doi/10.1093/neuros/ny x211/3786415?redirectedFrom=PDF Dr. Rosen Study https://www.ncbi.nlm.nih.gov/pubmed/28631104 ACS statement http://bulletin.facs.org/2017/10/the-surgical-cap-symbol-science-argument-and-evidence/   Cephalosporins and Cross Reactivity with Pencilin Allergy MGH Abx Study http://www.massgeneral.org/News/pressrelease.aspx?id=2157 https://www.aliem.com/2012/08/busting-myth-10-cephalosporin/ Post Operative Fevers https://www.ncbi.nlm.nih.gov/pubmed/20655062 Bowel Sounds and Return of Bowel Function https://www.ncbi.nlm.nih.gov/pubmed/28481855      

A story which starts knee-deep in sewage and ends with the spread of drug resistant infections like MRSA