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Questions discussed in this category

How would you approach treatment of latent TB for patients who cannot tolerate rifamycins or isoniazid due to allergy, intolerance, or drug-drug interactions?
4 Answers available
What is your preferred laboratory test to assess treatment response or infection resolution in patients with bacterial pneumonia?
For example, do you find trending WBC, procalcitonin, CRP, etc., more or less helpful?
1 Answer available
Do you recommend boric acid for patients with recurrent candida vulvovaginitis?
1 Answer available
What is your approach to secondary prophylaxis for C difficile infection during concomitant antibiotic use in a patient with a history of C difficile infection?
1 Answer available
For which patients or under which circumstances do you recommend a 9-month over a 6-month course of isoniazid for treatment of LTBI?
1 Answer available
In light of recent measles outbreaks in the US, would you recommend an MMR booster for an immunocompetent patients born before 1957?
4 Answers available
Do you routinely recommend transition to dual PO antibiotic coverage for strep species and MRSA, for patients with purulent cellulitis and in the absence of culture data?
2 Answers available
What is your preferred method for latent tuberculosis screening prior to outpatient hemodialysis initiation for a patient with new dialysis requirements?
3 Answers available
What duration of antibiotic therapy do you use for a loculated parapneumonic effusion that does not meet criteria for empyema?
6 Answers available
How long do you recommend that a patient wear a mask when resuming biologic infusions following a recent upper respiratory infection?
3 Answers available
What factors should guide the choice between fosfomycin and nitrofurantoin for uncomplicated cystitis, given the reduced efficacy of fosfomycin?
McCreary et al., PMID 37310038
2 Answers available
Do you routinely recommend doxycycline for pregnant individuals with rickettsial diseases despite the historical concern for side effects in pregnancy?
McCreary et al., PMID 37310038
1 Answer available
For which patients could you consider direct oral amoxicillin challenge as opposed to skin testing for penicillin allergy de-labeling?
2 Answers available
Do you usually recommend a modified diet for Clostridioides difficile infection (CDI)?
Either low fiber or high fiber, or other? Or probiotics?
1 Answer available
Is there any role for administering another course of recombinant zoster vaccine (Shingrix) in a previously vaccinated patient with RA, who is in clinical remission on JAK inhibitor but has had a breakthrough shingles infection?
The last SHINGRIX was about 4 years ago and both doses were given.
2 Answers available
Do you give chronic antibiotic prophylaxis for recurrent UTIs, including Pseudomonas aeruginosa, in a patient with retained ureteral stents?
4 Answers available
What is your approach to duration of fidaxomicin in a patient receiving treatment for first C difficile infection while also receiving concurrent antibiotics for an infection? 
Do you extend the course of fidaxomicin past initial 10 days to at least 3-7 days after completion of antibiotics?
1 Answer available
How do people approach non-HIV patients with hepatitis B, a negative Hepatitis B E antigen, normal LFTs and relatively low HBV DNA between 2000-20000?
2 Answers available
How do you use CD4% in clinical practice in management of patients living with HIV?
7 Answers available
Would you consider using long-acting injectable cabotegravir/rilpivirine for pregnant women with HIV?
2 Answers available
What is your approach to anal pap screening among MSM with HIV, and if routinely recommend, starting at what age (assuming access to HRA)?
2 Answers available
How do you manage resistant infections that persist after stopping antibiotic therapy in patients with non-CF bronchiectasis?
1 Answer available
How do you approach management for patient's with HIV on ART with persistent low level viremia but no new resistance mutations identified?
1 Answer available
What is your preferred oral regime with duration for treatment of onychomycosis?
How frequently can you repeat the oral course? 
4 Answers available
What patient-specific factors would influence your decision to initiate semaglutide therapy in patients with HIV-associated lipohypertrophy?
1 Answer available
What is your approach to the use of Paxlovid for patients with risk factors for severe Covid-19 infection but who have received SARS-CoV-2 vaccines in light of the EPIC-SR trial findings?
EPIC-SR Trial
3 Answers available
What duration of therapy do you recommend for patients with a vascular graft infection in which the graft has been removed and another graft placed in the infected space?
1 Answer available
Is there a role for beta-lactams as step-down oral therapy for uncomplicated gram-negative bacteremia?
If so, what antibiotic regimens do you use?
6 Answers available
What oral treatment options would you offer a patient with severe onychomycosis who is also on methotrexate for another condition?
2 Answers available
How would you manage a patient with progressive/refractory molluscum contagiosum who is well controlled on methotrexate for seropositive rheumatoid arthritis?
Are you aware of any data regarding relative risk of molluscum contagiosum infection in reference to DMARDs/biologics?
1 Answer available
What duration of antibiotics do you use in patients with Actinomyces osteomyelitis, i.e., do you stop after 6 weeks or do you give a longer oral antibiotic course?
1 Answer available
What is your approach to a positive PPD or IGRA in a patient with well-controlled HIV without significant TB risk factors?
3 Answers available
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
2 Answers available
What is your approach to recurrent asymptomatic bacteriuria in pregnancy for patients without personal history of recurrent UTIs or pyelonephritis?
Assuming patient already received an initial course of antibiotic treatment in response to a positive urine culture during routine screening early in ...
2 Answers available
What is your approach to deciding when to stop therapy for cutaneous Mycobacterium chelonae infections?
1 Answer available
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
1 Answer available
What steps do you recommend to ensure continued viral suppression and prevent drug resistance in an HIV patient on injectable cabotegravir and rilpivirine who misses their scheduled injection appointment by two weeks?
1 Answer available
How would you manage a patient with well controlled HIV on Biktarvy, who is interested in switching to injectable HAART but also has a history of a prior Hepatitis B Infection?
2 Answers available
Do you recommend starting anti-fungal prophylaxis for patients on systemic antibiotics who have a peritoneal dialysis catheter that is only currently being accessed for once weekly flushes?
1 Answer available
Is there a role for empiric scabies treatment in itchy patients without clear clinical signs of scabies? 
Do you empirically treat itchy patients -with a non specific rash- for scabies without obvious clinical findings for scabies? 
5 Answers available
Do you give additional pneumococcal vaccines after a dose of PCV20 in patients with asplenia?
1 Answer available
Would you recommend starting a moderate-intensity statin in a patient under the age of 40 years old with HIV and a 10-year ASCVD risk estimate below 5%?
The REPRIEVE trial included participants who were between 40 and 75 years old.
1 Answer available
Is there a role for cefpodoxime for treatment of acute cystitis caused by an Enterobacterales isolate with resistance to cefazolin, but susceptibility to ceftriaxone?
Can cefpodoxime susceptibility be reliably extrapolated from ceftriaxone susceptibility? 
1 Answer available
How have you adjusted your practice for treatment of syphilis in light of the penicillin G benzathine shortage?
3 Answers available
Under what circumstances would you recommend the maternal RSV vaccine for a pregnant patient if nirsevimab will also be available for the infant after birth?
1 Answer available
Do you recommend lifelong antibiotic prophylaxis, or do you prefer a more selective approach based on risk factors in asplenic patients without a history of severe infections?
2 Answers available
Is there any role for additional antiviral therapy during rebound from COVID-19 infection after a course of Paxlovid?
2 Answers available
How do you approach a positive Quantiferon/PPD test result in a patient for whom testing is sent without a clinical indication and who does not have a risk factor for TB exposure nor TB reactivation?
Do you routinely offer latent TB treatment in these cases?  
2 Answers available
Do you adhere to the standard 5-day minimum treatment duration for community-acquired pneumonia, or have you used shorter courses for certain low-risk patients?
1 Answer available
How do you counsel HIV patients with an undetectable viral load on breastfeeding?
2 Answers available
What is your approach to use of D-mannose for prevention of recurrent uncomplicated cystitis?
Especially in light of the results of the randomized clinical trial published on 8/2024 in Jama Internal Medicine by Hayward et al., PMID 38587819.
1 Answer available
Do you periodically check a urine culture for patients without dysuria but who have a history of struvite kidney stones and urinary tract infections with urease producing organisms?
1 Answer available
Do you use oral fosfomycin as a treatment option for uncomplicated cystitis due to ESBL producing E coli?
1 Answer available
For how long would you treat Klebsiella aerogenes folliculitis of the face manifesting as a cystic lesion?
Would you combine antibiotics with isotretinoin?
2 Answers available
Do you recommend antibiotic prophylaxis for an ESKD patient with a tunneled dialysis catheter who is planned for a dental procedure?
2 Answers available
What is your approach to counseling patients regarding re-initiation of anti-TNF therapy after completion of treatment for non-disseminated pulmonary histoplasmosis?
Would it be safe to resume and if so, when?
2 Answers available
Would you give treatment to a male patient with subjective dysuria but no objective pyuria with Ureaplasma urealyticum detected by PCR from urine?
1 Answer available
For how long do you recommend treatment for latent tuberculosis prior to initiation of anti-TNF therapy?
6 Answers available
How long do you treat an isolated bacterial liver abscess which has either undergone percutaneous drainage or for which an indwelling drain is placed?
3 Answers available
Is history of GBS a contraindication for all future flu vaccines?
2 Answers available
How do you apply the CDC PrEP guidelines for cisgender women, particularly when faced with underreported risk behaviors or uncertain partner HIV status?
1 Answer available
How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?
1 Answer available
What duration of therapy do you use for treatment of Legionella pneumonia in an immunocompetent host without associated empyema or extrapulmonary infection?
2 Answers available
Do you recommend testing for HPV in patients with oral lichen planus?
2 Answers available
How do you approach ongoing screening for TB in patients with a history of treated latent TB, but who have ongoing use of DMARDs and/or biologics given Quantiferon testing and PPD can remain positive?
How do you approach ongoing screening for TB in patients with history of treated latent TB, but have ongoing use of DMARDs and/or biologics given quan...
1 Answer available
For patients on PrEP, is there a role for HIV RNA PCR screening in addition to 4th generation antigen/antibody testing?
1 Answer available
Given recent data for use of doxycycline as post-exposure STD prophylaxis, how have you applied its use in clinical practice?
4 Answers available
When should vaccines be given if not received prior to the start of high dose radiation (40-50 Gy) to the spleen?
1 Answer available
Do you consider anti-viral prophylaxis in patients taking JAK inhibitors who have recurrent uncomplicated Zoster infection, but would prefer not changing therapy?
2 Answers available
What is the recommended treatment regimen for Mycoplasma genitalium in a pregnant woman?
1 Answer available
What is your approach to monitoring patients with the indeterminate form of Chagas disease?
1 Answer available
Given recent data from the REPRIEVE trial, how will you adapt your practice with regards to prescribing statins to patients living with HIV?
1 Answer available
How long do you continue surveillance with imaging and sputum cultures in a patient with NTM with no indications for treatment?
3 Answers available
Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?
1 Answer available
What is the optimal timing for Zoster vaccine administration for a patient who recently recovered from herpes zoster infection and is now planning to start B-cell depletion therapy?
1 Answer available
How do you approach COVID-19 vaccination in those with a prior history of glomerular disease?
2 Answers available
How do you approach management of patients with active RA and recurrent non-severe C.diff?
(Patient with active RA despite hydroxychloroquine)
1 Answer available
How do you approach treatment of RA with methotrexate in a patient with treated Hepatitis C and normal liver function?
1 Answer available
What topical or oral treatments do you recommend for patients with recurrent MRSA infections?
Do you recommend any changes to their personal hygiene practices? or changes to their environment?
1 Answer available
Do you ever stop tobramycin prophylaxis in a patient with chronic bronchiectasis previously colonized with pseudomonas?
2 Answers available
How do you approach patients with onychomycosis that does not respond to terbinafine and prolonged courses of fluconazole?
Would you switch to itraconazole or perform fungal cultures? When would you consider repeating the course of treatment? 
2 Answers available
Is there a role for regular hepatitis and TB screening in patients on chronic immunosuppressive therapy in the absence of new risk factors or exposures?
1 Answer available
Do you hold tocilizumab for patients who are diagnosed with Covid and are with mild to moderate symptoms or non-hospitalized?
1 Answer available
How are you timing the third dose of the COVID-19 mRNA vaccine in patients on rituximab?
1 Answer available
How long would you treat with antimycobacterials before starting biologic DMARD in a patient with latent TB and active rheumatoid arthritis?
1 Answer available
How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as anti-TNF alpha therapy?
For example, healthcare workers who require these vaccines for employment
1 Answer available
How would you manage methotrexate therapy in an active rheumatoid arthritis patient undergoing treatment for latent TB with rifampin?
Do you stop methotrexate or adjust the dose? 
1 Answer available
How do you approach the evaluation of patients referred for chronic lyme disease and counsel patients regarding this entity?
1 Answer available
Are you recommending the mRNA COVID-19 vaccines to your patients with immune mediated inflammatory diseases?
5 Answers available
Should tuberculosis screening be performed before beginning methotrexate for treatment of rheumatoid arthritis?
1 Answer available
What is your approach to dental prophylaxis for patients on biologics?
1 Answer available


Papers discussed in this category

Arthritis care & research, 2012-05
2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis.
Clin Infect Dis,
Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease.
Ann Rheum Dis, 2019 Aug 14
2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.
Arthritis Rheum,
Tuberculosis associated with therapy against tumor necrosis factor alpha.
Kidney Int Rep, 2021 Oct 06
COVID-19 Vaccination and Glomerulonephritis.
Kidney360, 2023 Mar 01
COVID-19 Vaccination and New Onset Glomerular Disease: Results from the IRocGN2 International Registry.
Kidney Int, 2022 Sep 10
Incidence of new onset glomerulonephritis after SARS-CoV-2 mRNA vaccination is not increased.
Kidney360, 2021 Dec 03
COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry.
Nephrol Dial Transplant, 2022 Jul 26
Perspective on COVID-19 vaccination in patients with immune-mediated kidney diseases: consensus statements from the ERA-IWG and EUVAS.
Clin Kidney J, 2021 Dec 21
Clinical spectrum of gross haematuria following SARS-CoV-2 vaccination with mRNA vaccines.
Clin Exp Nephrol, 2021 Nov 13
Gross hematuria after SARS-CoV-2 vaccination: questionnaire survey in Japan.
Kidney Int, 2021 Sep 14
COVID-19 vaccination followed by activation of glomerular diseases: does association equal causation?
J Am Soc Nephrol, 2022 Nov 04
A Population-Based Analysis of the Risk of Glomerular Disease Relapse after COVID-19 Vaccination.
J Am Soc Nephrol, 2020 Jul 17
Kidney Biopsy Findings in Patients with COVID-19.
Arthritis & rheumatology (Hoboken, N.J.), 2017-10
The Safety and Immunogenicity of Live Zoster Vaccination in Patients With Rheumatoid Arthritis Before Starting Tofacitinib: A Randomized Phase II Trial.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-06-01
Late Infection-Related Mortality in Asplenic Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.
Human vaccines & immunotherapeutics, 2017 Feb
Recommended vaccinations for asplenic and hyposplenic adult patients.
MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2021 Jul 23
Sexually Transmitted Infections Treatment Guidelines, 2021.
Microbes and infection, 2024 May 06
Secondary prophylaxis for Clostridioides difficile infection for patients on non-C. difficile antibiotics: a retrospective cohort study.
The Journal of infectious diseases, 2022 May 04
Recommendations for Screening and Diagnosis of Chagas Disease in the United States.
Arthritis Care Res (Hoboken), 2016 Jan
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.
Alimentary pharmacology & therapeutics, 2022 May 20
Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management.
JAMA network open, 2024 Jan 02
Early Switch From Intravenous to Oral Antibiotics for Patients With Uncomplicated Gram-Negative Bacteremia.
Infectious diseases and therapy, 2022 May 03
Legionnaires' Disease: Update on Diagnosis and Treatment.
American journal of respiratory and critical care medicine, 2019 Oct 01
Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America.
The New England journal of medicine, 2023 Apr 06
Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections.
Journal of translational internal medicine, 2019 Dec 31
Influenza Vaccination and Guillain-Barré Syndrome: Reality or Fear.
Current opinion in rheumatology, 2018 Jul
Trimethoprim-sulfamethoxazole and antineutrophil cytoplasmic antibodies-associated vasculitis.
European journal of medical research, 2009 Dec 07
Co-trimoxazole and prevention of relapses of PR3-ANCA positive vasculitis with pulmonary involvement.
Annals of the rheumatic diseases, 2018 Jun 27
Trimethoprim-sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015-08-01
Histoplasmosis complicating tumor necrosis factor-α blocker therapy: a retrospective analysis of 98 cases.
The New England journal of medicine, 2024 Apr 04
Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19.
Circulation, 2008 Jun 09
Bacteremia associated with toothbrushing and dental extraction.
Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 1999 May-Jun
Prophylactic antibiotic therapy prior to dental treatment for patients with end-stage renal disease.
Nephrology (Carlton, Vic.), 2004 Jun
Antibiotic prophylaxis in dialysis patients undergoing invasive dental treatment.
Lancet (London, England), 2021 Mar 27
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.
Lancet (London, England), 2021 Mar 27
How low can we go in community-acquired pneumonia therapy?
World journal of urology, 2013 Apr 30
D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial.
JAMA internal medicine, 2024 Apr 08
d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial.
The Cochrane database of systematic reviews, 2022 Aug 30
D-mannose for preventing and treating urinary tract infections.
Lupus, 2014 Jul 30
Serious infections in systemic lupus erythematosus with a focus on pneumococcal infections.
MMWR. Morbidity and mortality weekly report, 2024 Sep 12
Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024.
Journal of fungi (Basel, Switzerland), 2019 Sep 04
A Week of Oral Terbinafine Pulse Regimen Every Three Months to Treat all Dermatophyte Onychomycosis.
The New England journal of medicine, 1987-03-05
Accelerated loss of antibody to hepatitis B surface antigen among immunodeficient homosexual men infected with HIV.
Hepatology (Baltimore, Md.), 2018 Apr
Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020 Dec 31
Global Burden of Hepatitis B Infection in People Living With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis.
Journal of viral hepatitis, 2019 Dec 22
Prevalence and burden of HBV co-infection among people living with HIV: A global systematic review and meta-analysis.
Topics in antiviral medicine, 2023 Mar 31
Chronic hepatitis B and HIV coinfection.
Journal of acquired immune deficiency syndromes (1999), 2023 Oct 01
Brief Report: Hepatitis B Infection or Reactivation After Switch to 2-Drug Antiretroviral Therapy: A Case Series, Literature Review, and Management Discussion.
American journal of respiratory and critical care medicine, 2019 Nov 15
Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline.
The Journal of infectious diseases, 2007-12-15
Decreased adherence to antiretroviral therapy observed prior to transient human immunodeficiency virus type 1 viremia.
AIDS (London, England), 2021 Nov 01
HIV-1 viral blips are associated with repeated and increasingly high levels of cell-associated HIV-1 RNA transcriptional activity.
Current HIV/AIDS reports, 2023 Nov 13
Learning from Persistent Viremia: Mechanisms and Implications for Clinical Care and HIV-1 Cure.
MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 1992 May 08
Guidelines for the performance of CD4+ T-cell determinations in persons with human immunodeficiency virus infection.
Lancet (London, England), 2013-02-09
Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study.
Clinics in liver disease, 2023 Jul 27
Chronic Hepatitis B: Treat all Who Are Viremic?
N Engl J Med,
Intrapleural use of tissue plasminogen activator and DNase in pleural infection.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024 Dec 17
Long-Acting Injectable Cabotegravir and Rilpivirine in a Pregnant Woman With HIV.
HIV medicine, 2022 Nov 21
Pregnancy outcomes and pharmacokinetics in pregnant women living with HIV exposed to long-acting cabotegravir and rilpivirine in clinical trials.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2011-03-01
International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
Clinical therapeutics, 1999 Nov
Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection.
JAMA, 2018 May 01
Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial.
The Medical letter on drugs and therapeutics, 1997 Jul 18
Fosfomycin for urinary tract infections.

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