Brad Spellberg @BradSpellberg Twitter profile

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Brad Spellberg

6 months

Thx to @Absteward for finding new Shorter Is Better RCT, 2 days of CTX = 5 for variceal bleeding. This is the 2nd such trial (2-3 d = 5-7 d). Id wager 1 d = 5 d, & if careful exclude infxn on admission (original studies not careful), 0 d needed? Need RCT

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Brad Spellberg

@BradSpellberg

3 years

Are we over-reading Israel's experience? Iceland & Denmark haven't had severe COVID return. And in LA, 8 months into vaccination, at the 2 public hospitals I'm currently CMO at, 693+ tests since July: 90% of all tests in unvaccinated 98% all admissions due to COVID unvaccinated

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Brad Spellberg

@BradSpellberg

2 years

@Dave99117584 @joaquinlife ERs are indeed very busy and hospitals are full because beds are closed because we can’t find enough nurses. But we are not busy with Covid. We are busy with patients who don’t have Covid, many of whom have had care deferred for > 2 years.

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Brad Spellberg

@BradSpellberg

3 years

Having chart reviewed all COVID+ at 2 public hospitals in LA since early July: 90% of pts with +test not vaccinated 96.4% of pts with +test admitted to hospital for any reason not vaccinated 98.2% of pts with +test admitted to hospital d/t COVID not vaccinated. That is all.

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Brad Spellberg

@BradSpellberg

2 years

I'm really impressed with @ShellenbergerMD 's book, San Fransicko. Im pretty familiar with the barriers and complexities of caring for the homeless given my day job. But Michael's book has challenged long-standing dogmatic presumptions. My mind is swirling with new possibilities!

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Brad Spellberg

@BradSpellberg

2 years

@StribGuy People have been predicting the end of the world for as long as people have had written language. How about we all try to take a deep breath and make 2023 >/=10-fold less unnecessarily dramatic as 2022?

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Brad Spellberg

@BradSpellberg

4 years

Finally got around to updating Shorter Is Better Table, now with 10th CAP trial (pediatrics) included. Updated 7/12/20:

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Brad Spellberg

@BradSpellberg

2 years

Confession: I haven't been on a plane in >2 years, and Im reluctant. But invited to give a talk on oral Abx at ID Week. I was hoping it would be virtual, but apparently not. I guess I have some COVID PTSD. Should I do it? Are people comfortable traveling at this point?

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Brad Spellberg

@BradSpellberg

3 years

@eliowa I can tell you that at the two public hospitals in LA for which i review all Covid + tests, at this point only 1/3 of Covid+ admissions are admitted because of Covid. And only 20-25% +tests in ED are admitted. Agree, reliance upon administrative data is misleading.

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Brad Spellberg

@BradSpellberg

4 years

@jdangjackson Used to see lots of that. But rifabutin is now a promising option for such cases. And colistin is still there. And there’s eravacycline and cefedericol.

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Brad Spellberg

@BradSpellberg

4 years

Alright ID Tweeps, Shorter Is Better table is now updated with new DFO study. Table is getting awfully full!

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Brad Spellberg

@BradSpellberg

2 years

General observation. It's really hard to be in the middle. You take flak from both extremes. Which is why it's all the more important that we try to move towards the middle. Decreasing polarization is good, don't you think?

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Brad Spellberg

@BradSpellberg

5 years

Note to the world. I’m sick to death of admitting young women to the hospital with advanced stage cervical cancer. It’s tragic and totally preventable. Vaccines save lives. Deniers kill.

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Brad Spellberg

@BradSpellberg

4 years

Update Shorter Is Better Table! 12 CAP studies now! 3 days taking over from 5?

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Brad Spellberg

@BradSpellberg

4 years

Given the popularity of the Shorter Is Better website, and the need to move ID to oral Abx for better patient care, I've added a new webpage: oral Abx tables/references for osteo, bacteremia, endocarditis. Would love feedback. Am I missing studies?

Oral Antibiotic RCTs | mysite

www.bradspellberg.com

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Brad Spellberg

@BradSpellberg

3 years

Updated Shorter Is Better tables with new (13th!!!) CAP trial!

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Brad Spellberg

@BradSpellberg

4 years

Slides 14-18 from my antibiotic stewardship talk. Any of this resonate with you, Dr. Wright? Or other stewards out there?

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Brad Spellberg

@BradSpellberg

3 years

Updated Shorter Is Better Tables, with the new (3rd) Gram Negative Bacteremia RCT incorporated, and clarification that skin infection trials include cellulitis, wound infections, and major abscesses.

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Brad Spellberg

@BradSpellberg

1 year

Updated Shorter Is Better Tables! Thanks to @PharmDFarmD for finding 2019 RCT of 1 vs. 6 day abx post appy. Amazing that after 15 yrs looking, sometimes studies still slip through the cracks. The power of crowd sourcing to ensure we know all the data!

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Brad Spellberg

@BradSpellberg

3 years

Updated Shorter Is Better tables: fantastic new JAMA male cUTI RCT by @Ddrekonja and colleagues! Not only important for short course, but either TMP-SMX or FQs used; 7 d TMP-SMX works for cUTI! Also included the single dose azithro for atypical CAP study @wfwrighID found.

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Brad Spellberg

@BradSpellberg

3 years

Shorter Is Better table updated, now with new Shorter Is Better Exceptions companion table! Updated osteomyelitis/PJI RCTs. Updated with Pulmonary TB RCT.

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Brad Spellberg

@BradSpellberg

2 years

@zchagla @TorontoIDDoc @gregbradyTO @DrToddLee @jakescottMD @VPrasadMDMPH @Saikmedi @BogochIsaac @drsandypants @GilNimni @dervishgirl1 I review all Covid+ pts at my hospital. <10% have symptoms at this point. And seems to be further declining this week.

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Brad Spellberg

@BradSpellberg

2 years

Updated Shorter Is Better tables with new high risk neutropenic fever study (3 d vs. >8 d) from Europe, and new Erythema Migrans study included. Thanks for finding them @ABSteward !

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Brad Spellberg

@BradSpellberg

3 years

Chutzpah: The act of refusing to accept 20 concordant RCTs demonstrating oral Abx work for osteo, bacteremia, & endocarditis, while having 0 (bubkus) contrary RCTs. You listening national guidelines? Yeah, we're looking at you!!! @DoctorRachael @medrants

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Brad Spellberg

@BradSpellberg

5 years

Okay ID Twitter, you asked, so I tried. How does below look as pilot re-design of Shorter Is Better table? Added in the 1 negative RCT of fluclox for cellulitis in footnote, too. I think I can't fit total N on the slide, but maybe I could on website. Thoughts? Re-design further?

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Brad Spellberg

@BradSpellberg

1 year

@ABsteward @DrToddLee I hate to be "that guy". But, heck, I am that guy. Neither cefepime NOR pip tazo should be empiric Tx for community infections going to ICU. Pseudomonal agents should be reserved for HAIs. Overuse of these Abx is 1 of the great failings of national stewardship efforts/guidelines.

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Brad Spellberg

@BradSpellberg

5 years

@ABsteward @ARD_BMJ @gompfsidpearls @SIDPharm @accpinfdprn @IDstewardship @KisgenUF @WesKufel @blandman19 @PhilipBejon @ThwaitesGuy @TheIDApprentice @ErinMcCreary Indeed I've already updated the table. It's getting very full!

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Brad Spellberg

@BradSpellberg

1 year

Thanks to @absteward and Dr. Davie Wong for finding the new oral vs. IV for GNB bacteremia in CMI. Added to Table and website. It's the 11th published trial showing oral = IV for bacteremia (SABATO will be #12 ). How much data do we need?

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Brad Spellberg

@BradSpellberg

5 years

Preparing talk on new abx for a local hospital. Updated table of abx approved since 2009 showing that most are not needed or redundant--look for an Annals of Internal Medicine paper coming soon (accepted!) describing how we need to change our targeting of new Abx:

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Brad Spellberg

@BradSpellberg

3 months

Hence my Antibiotic Stewardship for the 21st Century Lecture: slides

Thom “NAC” Mack

@ThommyTox

3 months

@BradSpellberg @ABsteward @DrToddLee Imagine being a pharmacist & you politely/professionally state [insert med] isn’t needed… MD: Yeah, I get that but the patient is sick. PharmD: Yeah, it’s a hospital, everyone here is sick. MD: [insert angry threats] PharmD: Here’s your med

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Brad Spellberg

@BradSpellberg

5 years

Okay, updated short course table with primaquin for vivax malaria included. Getting awfully crowded!

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Brad Spellberg

@BradSpellberg

2 years

I wish there was a way to inculcate into doctors the need to order tests more rationally. The number of useless ESRs, CRPs, beta glucans, quant golds, etc, ordered is staggering. And often lead to inappropriate Abx or other Tx. How do we stop this?

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Brad Spellberg

@BradSpellberg

3 months

3 daily rants in one week? A new record! It's a fair question. And the answer is, no. Even in immune suppressed patients there is no evidence that cidal vs. static means anything. Why?

Cosmina Gingaras MD, MPH

@CosEpiID

3 months

@BradSpellberg @DrToddLee @ABsteward Can I ask whether the old-fashioned concept of static and cidal has any bearing in choosing antibiotic regimens in severely immunosuppressed patients?

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Brad Spellberg

@BradSpellberg

2 years

Updated Shorter Is Better tables with the 2 new RCTs @ABsteward found! 1 new post op prophylaxis, shorter was better. 1 new exception, chronic pulmonary aspergillosis (very long was inferior to very very long).

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Brad Spellberg

@BradSpellberg

9 months

Shorter Is Better tables updated with Empyema RCTs found by @PulmCrit and @MaartenVHemelen . The Tables are getting very full, running out of space! Are we seeing the pattern here??? Added verbiage on possibly going even shorter for empyema on the website.

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Brad Spellberg

@BradSpellberg

3 years

At @ABsteward 's request, TB is pulled out into its own brand new table, including adding seminal short course, historical TB studies. So now there are 3 Shorter Is Better Tables. The original. TB Is Complex. And Exceptions. If you know of other TB RCTs, let me know!

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Brad Spellberg

@BradSpellberg

1 year

Thanks to @ABsteward for finding the latest Shorter Is Better RCT! 4 vs. 8 days post source control for cIAI (cholangitis in this case). The 3rd cIAI study, not including 2 other perfed appy studies. Tables updated.

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Brad Spellberg

@BradSpellberg

5 years

Final Shorter Is Better updated 11/3/19--link to webpage listing all the RCTs, with a tally of total number of patients studied thus far for each disease. References at

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Brad Spellberg

@BradSpellberg

2 years

Updated Shorter Is Better tables, with new 6 mo all oral vs. 9-20 mo standard Tx for rifampin-resistant TB in the TB Is Complex Table. Thanks to @ABsteward for finding the study first, as always!

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Brad Spellberg

@BradSpellberg

11 months

I don't know how many times I need to say this, or how I can say this more clearly. There is nothing magical about IV antibiotics. Period. They are not "more powerful" than oral antibiotics. They are not more effective than oral antibiotics. They are, generally, less safe.

Alice Han

@dralicehan

11 months

So #IDTwitter What do you think? Switch to po for your immunocompromised patients? Any caveats? Neutrophil engraftment? Functioning GI tract? Could we switch sooner? @BradSpellberg @IdVilchez @Gnfidz @mangarone23 @tmhohl71 @DrToddLee

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Brad Spellberg

@BradSpellberg

3 months

Okay @radiokeller , you asked for a combo Abx therapy rant, so here it comes (I guess Im taking requests now! ;)). There are 3 philosophical reasons to use combination Abx therapy (see my Mandell chapter for this discussion in detail). But they all apply differently to difft dzs.

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Brad Spellberg

@BradSpellberg

2 years

Updated Shorter Is Better master tables with the 56th <1 day periop prophylaxis RCT included. We're just piling on at this point, no? @ABsteward References listed at

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Brad Spellberg

@BradSpellberg

2 years

@dralicehan @JLimHospMD @saahirkh About 10% of our Covid+ admissions are admissions due to Covid. And of the very rare due to Covid ICU admissions, they are not for pneumonia. We haven’t had a severe Covid pneumonia in months. Not a narrative that aligns with media hype. But it’s what we’re seeing.

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Brad Spellberg

@BradSpellberg

2 years

Serious question. Since all current COVID therapeutics were studied in RCTs prior to the last 12 months, can any of these therapies be assured to net result in meaningfully better outcomes (benefit:harm) now that the average severity of cases is substantially improved?

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Brad Spellberg

@BradSpellberg

5 years

I’m troubled by presumption that -PCR means not the flu, & +PCR means COVID. All season I’ve been seeing classic flu pts with -PCRs. And there must be a false+ rate for COVID. More tests in low pre test prob will mean more false+. Think we should be careful speaking in absolutes.

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Brad Spellberg

@BradSpellberg

2 years

Shorter Is Better Tables update, new 2 vs. 5 day study for complex appendicitis--thank you as always to @absteward for finding! And added footnote to rifampin-resistant TB RCT emphasizing benefit was to safety and study was underpowered on efficacy to address @tomyates concern.

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Brad Spellberg

@BradSpellberg

3 years

Yes! 👇🏼 SO this!!! Amazingly whenever i ask people if cystitis causes fever, they always say no. Then i ask, so why did you send a urine Cx to work up nosocomial fever? You thought they had a hospital onset pyelo? They stare at me blankly. The cognitive dissonance is astounding.

Jocelyn J. Fitzgerald MD

@jjfitzgeraldMD

3 years

Stop sending urinalyses and urine cultures in people without urinary symptoms!

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Brad Spellberg

@BradSpellberg

2 months

Okay by popular demand, as requested, another ID/abx rant. Let's talk abx "spectrum of activity" vs. selecting for resistance. Does it make sense to use PCN rather than amp or amox to "reduce selection for resistance"? Nope. I know. Confusing.

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Brad Spellberg

@BradSpellberg

3 years

Updated Shorter Is Better Table! Thanks to @MaartenVHemelen who just found 2 previously unlisted RCTs for cUTI, both including men! One compared 2 vs. 4 weeks (long vs. very long) so not included in table, the other now added. Latest below, with refs at

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Brad Spellberg

@BradSpellberg

3 years

@ScenarioRosey @eliowa No this is current info, definitely in the era of omicron. It is a change, almost as if two separate pandemics. Last winter surge, 80% of positives were admitted, >90% admitted due to Covid, and nearly half admissions were to the ICU. Last winter was much worse, at least so far.

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Brad Spellberg

@BradSpellberg

2 years

@SachaNicoletti @Susan_Shelley @Dave99117584 @joaquinlife There is a serious national nursing shortage. Many nurses have left the profession. It will take several years for nursing schools to graduate enough nurses for us to catch up. Until then, there will be bed shortages and full EDs.

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Brad Spellberg

@BradSpellberg

2 years

Soon to wrap up another go around on ID consult service, and some observations to share. Some may be controversial, but things humming along and the team running like a well-oiled machine, thought I'd begin a dialogue. 2 major observations, with detail for both.

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Brad Spellberg

@BradSpellberg

4 years

Thanks to Jake Tapper and team for having me on today. Covid continues to increase in CA and LAC. @jaketapper @CNN

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Brad Spellberg

@BradSpellberg

2 years

Updated Shorter Is Better Tables, thanks to @ABsteward for finding the new RCT of 6 mo all oral Tx for MDR TB, non inferior to > 9 months with an injectable regimen!

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Brad Spellberg

@BradSpellberg

2 years

Updated Shorter Is Better tables. Drs. @DoctorRachael and @FDominguezID convinced me to tackle complexity of the original Singh '00 RCT. It wasnt CAP or VAP. It was actually low probability (i.e., there likely was no PNA) CAP, HAP, VAP all in 1. #1 /3

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Brad Spellberg

@BradSpellberg

2 years

Updated Oral vs. IV Abx tables, per suggestion of @ABsteward . Some important points. 1) Tables only list Oral vs. IV-only abx trials. Turns out, oral is so common for peds osteo that there are no studies where the control arm got IV-only Tx.

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Brad Spellberg

@BradSpellberg

4 years

Below table (slide 2 of my Stewardship talk) summarizes mortality of infections with vs. without abx, with citations. Pneumonia specifically cites 2008 position paper on clinical trials for CAP, and the historical references are in its Table 2, below.

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Brad Spellberg

@BradSpellberg

2 years

Updated Shorter Is Better tables, thanks to @jonbachna_PAST for finding the variceal bleeding 3 vs. 7 day trial! Now we need RCT comparing 1 dose + de-escalation vs. 3-7 d abx, while actively excluding infxn. Refs at .

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Brad Spellberg

@BradSpellberg

2 years

@AWokeZombie @jwilcox79 Not at all. This is not conspiracy stuff. This is hard stuff to count. It’s not a conspiracy and the world is not full of evil people. Good heavens people, chillax. When Covid was severe, the death counts were accurate. They become decreasingly accurate when less severe.

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Brad Spellberg

@BradSpellberg

5 years

It’s a shame more ID docs don’t round on gen med also. Might change the view that we should liberalize use of new abx. Picked up team today. 80% pts on Abx. 1/3 need them. Abx being used to treat CHF, CA, viruses, and general clinician worry. Stewards are modern Sisyphuses.

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Brad Spellberg

@BradSpellberg

6 years

@AnnCoulter It takes a truly special skill at misdirection and disingenuity to turn a conversation about the flood of shattered lives bullets have filled our EDs and ORs with and convert the discussion to gummy bears. 👏 bravo. Spend a week with our trauma team. You might feel differently.

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Brad Spellberg

@BradSpellberg

5 years

@ABsteward @Stevens_AK Last version updated based on Twitter vote that malaria should be included.

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Brad Spellberg

@BradSpellberg

3 years

Shorter Is Better tables and website updated! Latest RCT included. Active TB in kids down to 4 mos. Can a 4 mo regimen for adults be far away???

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Brad Spellberg

@BradSpellberg

1 year

Updated Shorter Is Better tables! Added a great find by @ishminderkaurID , a 2009 short course study (10 vs. 30 days) of septic arthritis in children by the prolific, H. Peltola! Reference added to website.

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Brad Spellberg

@BradSpellberg

3 months

I guess it's time for my daily rant. Im old enough to remember when this first negative day of culture nonsense started. Back in the bad old days of the cretaceous era, when I was an ID fellow and rode the brontosaurus to work...

Helmi Sulaiman

@edenhelmi

3 months

In complicated/high-risk MSSA/MRSA bacteremia, when do you count day 1 of the therapy following appropriate treatment? #IDtwitter @syctong @Josh_S_Davis @alif82 @shaharudeen and others?

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Brad Spellberg

@BradSpellberg

5 years

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Brad Spellberg

@BradSpellberg

2 years

@itosettiMD_MBA @jwilcox79 At my hospital we review all charts. That’s why i can tell you that >90% of Covid+ tests are incidental. But we don’t do the public reporting. Do you think that population level reporting of Covid deaths, across millions of people in communities, is done by chart review?

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Brad Spellberg

@BradSpellberg

2 years

I tried to do that in the Principles of Anti-Infective Therapy chapter in the Mandell text. 10 sequential principles which, if followed, help optimize abx usage. 1) Before picking abx, start with an accurate differential diagnosis 2) Only give abx when they will improve outcome

Boris Jegorović, MD, PhD, DTM&H

@BJegorovic

2 years

@BradSpellberg @PulmCrit Can you write a book with case examples from your practice, so we can all learn better and right ways?

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Brad Spellberg

@BradSpellberg

3 years

Updated COVID # in LA County, 73% fully vaccinated--10 million people, would be the 10th largest state in the US. Despite all the the Delta variant hype, the problem is not Delta. It's unvaccinated people. To this day, only 6% of hospital admissions for COVID vaccinated.

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Brad Spellberg

@BradSpellberg

3 years

The power of vaccines! 6 mo ago LACUSC had 275 covids in hospital, with >60 new + admissions/d. 1 year ago at this time, 120 in hospital, >30 new/day. Now that CA is reopened? Only 2 in hospital, both trauma pts with incidental + test. Virtually no new symptomatic admissions.

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Brad Spellberg

@BradSpellberg

3 years

Procalcitonin can be incredibly valuable as a psychological tool to help provider have the courage to do the right thing. It is a biomarker of safety to withhold Abx. People who say it has no value may be trying to use it as a diagnostic. Not it’s use or purpose.

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

3 years

@tmhohl71 No value! Thanks what about this study and other RCTs eg sepsis or others , maybe in some conditions when physicians use it in the right time and the right condition ? @BradSpellberg #IDTwitter #medtwitter #TwitteRx

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Brad Spellberg

@BradSpellberg

6 months

Per @absteward 's request, here are updated slides showing # new abx approved by 5 year periods, & table showing specific new Abx since 2009--green = meets unmet need; yellow = sorta maybe has some use; red = does not address unmet need. We continue to get new abx we don't need.

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Brad Spellberg

@BradSpellberg

8 months

Amazing that after years of searching and collating, people (usually @absteward !) still find Shorter Is Better studies we didn't know about! 2 more Lyme disease studies added to table thanks to Dr. Ghanem. One from 1983! Who knew!? References at

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Brad Spellberg

@BradSpellberg

4 years

My 🧠 hurts. Pre COVID, huge limit to stewardship was docs saying, sorry, i have to follow natl guidelines so can’t listen to u. Medical-legal. Post COVID, docs saying, couldn’t care less about guidelines, have to Rx tocilizumab, medical-legal. Are we in bizarro world or what?

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Brad Spellberg

@BradSpellberg

4 years

Today on ID rounds, 3 pts right out of Andriole ID Fellows Board Review lecture on bacterial syndromes last week. 1) wound botulism in skin popper; 2) Step anginosis liver abscess; 3) brucella vs TB lumbar osteo. Seriously. Literally identical to cases in the talk. ID is cool.

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Brad Spellberg

@BradSpellberg

3 years

Fair warning to anyone with the misfortune of admitting me to the hospital. I will be questioning everything you do? Why do you need that test? How will it change management? Why can’t i get this care at home? Whatre the data for this drug? Or intervention? Apologies in advance.

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Brad Spellberg

@BradSpellberg

4 years

Have any other ID tweeps noticed that more docs are treating Klebsiella aerogenes with cephalosporins than used to so treat Enterobacter? An enterprising scholar might study this. I’m thinking the name change may be resulting in bad outcomes.

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Brad Spellberg

@BradSpellberg

7 years

Let's put this to rest. Here's a tweet thread of RCTs (1st auth, Journal, Year, volume, 1st pg) demonstrating short course Abx as effective as longer, often with less resistance & AE rates (due to reference limits, couldn't include all these in JAMA IM paper)-- #shortcourseAbx .

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Brad Spellberg

@BradSpellberg

2 years

Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review

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Brad Spellberg

@BradSpellberg

4 years

Thanks to former super ID Fellow, Dr. Fernando Dominguez (who has recently joined Twitter, follow him at: @FDominguezID ) for pointing out 6 RCTs on shorter Abx for acute bacterial sinustis. Updated Table is below, and with references on website:

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Brad Spellberg

@BradSpellberg

1 year

You may be wondering, how can 1 vaccine improve survival for blood and lung infections caused by MRSA, VRE, ESBL E. coli, carbapenem R Acineto, Pseudomonas, and Klebsiella? 2 words for you: TRAINED IMMUNITY! The future of vaccines!

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

1 year

Wow! 🔥 Just published 🔥 @ScienceTM A remarkable work by @BradSpellberg et Al A Protein-Free Vaccine Stimulates Innate Immunity and protects against bacterial & fungal pathogens that cause HAIs If it works in humans the way it does in mice? Game changer!

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Brad Spellberg

@BradSpellberg

6 years

All the RCTs i know of demonstrating shorter as effective as longer for bacterial infections are listed. Thx to CID editors for allowing so many references in one editorial.

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

6 years

NEW🔥🔥 in CID by @BradSpellberg Short Course Antibiotic Therapy—Replacing Constantine Units with “Shorter Is Better”

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Brad Spellberg

@BradSpellberg

7 months

Today on Medicine rounds, discussion re how long to Tx CAP. Med students said 3 days! I said, fantastic! I told em back in the cretaceous era when I was a student & rode a brontosaurus to work, I was taught 14 d. Residents & students were horrified! There's hope yet @absteward !

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Brad Spellberg

@BradSpellberg

3 years

@BogochIsaac @TimLaheyMD At LACUSC we see 5-10 new COVID+/day, for 9th straight week. And NONE hospitalized for covid. All false+, presenting for other medical problems, likely infected 2-5 mos ago, cuz we’re testing all admissions (needs to change soon). Counting hospitalizations no longer accurate.

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Brad Spellberg

@BradSpellberg

4 years

@JosephNSanberg @wendellpotter If we removed your need to pay for health insurance benefits you could give a 10-15% pay raise off the bat and still have excess capital left to reinvest in your business! Single payer system would be the biggest pro business growth boon, while increasing worker pay!

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Brad Spellberg

@BradSpellberg

4 years

Andy Shorr, the consummate academic physician, found the below important scientific article which has somehow thus far eluded attention. It should be discussed in all journal clubs.

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Brad Spellberg

@BradSpellberg

4 years

Oral therapy is the new shorter course therapy. The weight of trial data is overwhelming. OPAT has become the Atari of ID.

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

4 years

Interesting! #AAC Oral step-down therapy for uncomplicated streptococcal BSI with a BL is non-inferior to a FQ. @MayaBeganovic1 #IDTwitter @ASMicrobiology

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Brad Spellberg

@BradSpellberg

2 years

Shorter Is Better updated with new febrile cUTI in men RCT in the Exceptions table with a question mark and footnote. On the website, commentary of why Im pretty reassured that 7 days normal dose FQ fine for this syndrome adjacent to the reference.

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Brad Spellberg

@BradSpellberg

2 years

@chancellor61 @StribGuy Global warming is a serious problem, & we need to do something about it. There are other real problems too. But when people say civilization is going to end & we'll all be dead in 50 yrs, credibility is lost. That isn't science. We need deliberate, rational action. Not hysteria.

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Brad Spellberg

@BradSpellberg

2 years

@ABsteward If you’re going to give antibiotics to patients who don’t need them, at least do the courtesy of giving them for a brief period of time.

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Brad Spellberg

@BradSpellberg

4 years

Excited to announce that my new book, Broken, Bankrupt, and Dying, will be launching on June 30th. The book is an examination of our deeply broken U.S. healthcare system, and the nonpartisan methods we can use to start to repair it. Stay tuned for details!

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Brad Spellberg

@BradSpellberg

6 months

Does anyone else think that maybe we over diagnose HLH these days, that the criteria are overly sensitive for identifying which patients need frieking chemotherapy as opposed to treating the underlying dz? I mean, sometimes you need to. But it feels maybe more common these days?

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Brad Spellberg

@BradSpellberg

3 years

@AMLandryMD I do it because it saves about 6 ATP molecules of effort that would be required to type the additional word, “Regards”. Similarly, it’s “100%”, rather than “yes I agree 100%.” That one saves 3 words and 8 ATP molecules. We’re all very concerned about our ATP expenditure.

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Brad Spellberg

@BradSpellberg

3 years

Hear ye, hear ye, now hear this! CONTINUING TO TAKE ANTIBIOTICS AFTER PEOPLE FEEL BETTER (OR ANY FOR VIRAL INFECTION) DOES NOT PREVENT ANTIBIOTIC RESISTANCE! IT PROMOTES IT! Can we please kill this zombie urban legend that just won’t die no matter how many times we shoot it?

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Brad Spellberg

@BradSpellberg

9 months

Updated Shorter Is Better tables with 3 changes! Included 2 peds UTI studies, thanks to @absteward & @AlbertoEMaraolo for finding. Included cystic fibrosis exacerbation, thanks to @pulmcrit for finding. References with commentary at

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Brad Spellberg

@BradSpellberg

5 years

I’m coining new sign: +smartphone sign (sitting up in bed comfortably playing with phone w/both hands). Has 99% NPV for needing Meropenem. Eg: ICU calls, pt unstable, need mero On eval from across the ICU, visually confirm +smartphone sign, so no need for mero, cont CTX.

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Brad Spellberg

@BradSpellberg

3 years

More on COVID in LA. Below graph is of +tests across LA County reported by DPH. 1) The massive surge winter 2020 was pre-delta. 2) The current delta "surge" doesn't compare. 3) And it already appears to be waning. 4) In 7/20, LACUSC had 120 COVIDs in hospital. 1/21, 280. Now? 30

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Brad Spellberg

@BradSpellberg

3 years

Here an easier one. What percentage of time is “bilateral LE cellulitis actually cellulitis”? 10%? 3? 1? 0% Why does this diagnosis persist?

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Brad Spellberg

@BradSpellberg

4 years

Just got my flu shot. Retweet as a reminder! Getting vaccinated is patriotic. We’re all in this together!

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Brad Spellberg

@BradSpellberg

3 months

@MikeRey92144159 @ABsteward I’ll take the 1 in 10,000 incidence of tendon rupture over the >10% incidence of serious PICC complications (DVT, line infections, central venous stenosis, etc) not including AEs from the Abx itself. I won’t tell you how to do anesthesia if you let us handle the infections.

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