CEimpact Podcast

Antibiotic Essentials - New Approvals and Clinical Refreshers

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Pharmacists play a critical role in infectious disease care, and staying up to date on antibiotic therapies is key to ensuring optimal patient outcomes. This episode reviews recently FDA-approved antibiotics, offers a practical refresher on commonly used antibiotic classes, and highlights frequent side effects—along with strategies for managing them in practice. Tune in to strengthen your clinical knowledge and support safe, effective antibiotic use across care settings.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Hunter Rondeau, PharmD, BCIDP, AAHIVP
Antimicrobial Stewardship Coordinator
SSM Health

Joshua Davis Kinsey has no relevant financial relationships with ineligible companies to disclose. 

Hunter Rondeau is a consultant for Pyrls, a speaker for ASHP, and was a speaker for ACCP (ended October 2025) and Vituity (ended May 2025). All relevant financial relationships have been mitigated. 

 
CPE REDEMPTION
This course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation:


CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify newly FDA-approved antibiotics and their clinical indications.
2. Describe commonly used antibiotic classes, their typical side effects, and strategies to manage or mitigate those effects.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-362-H01-P
Initial release date: 11/24/2025
Expiration date: 11/24/2026
Additional CPE details can be found here.

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SPEAKER_02:

Hey CE Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and as always, I'm excited about our conversation today. Antibiotics are a cornerstone of patient care, but with new approvals, shifting resistance patterns, and forgotten fundamentals, it's easy to fall behind. In this episode, we'll revisit key antibiotic classes, introduce newly approved agents, and share practical insights to help you make informed, confident decisions as you prescribe and manage treatment regimens for your patients. It is so great to have Hunter Rondo with us as our guest for today. Hunter, welcome. Thank you. Thanks for having me. Yeah, we're so glad to have you. Thanks for giving us your time. For our listeners who don't know much about you, go ahead and tell us a little bit about yourself and maybe your practice side. And as I always like to say, your passion for the profession. So tell us a little bit about yourself.

SPEAKER_01:

Of course. So, like I said, my name's Hunter Ondo. I'm a regional antimicrobial stewardship coordinator at SSM Health in St. Louis. So what that means is I've got three hospitals that I support as a like system liaison for our health system. Um I'm primarily at one site that, well, it's a community hospital, it very much feels like an academic medical center at times. I also jokingly say it's a little bit bigger than our health system's academic medical center to kind of tease them. And then I have two other hospitals, one that's a commu a little bit smaller community hospital, and then another one that's further out that's a little bit farther away from our health system. So there's quite a diversity in my practice. I get a little bit of telehealth with some of our ID teams. Oh, wow. I see I get to serve North County, St. Louis. So that's a very medically underserved population. So I went from really not having to deal with HIV to now I'm like my team's HIV pharmacist when it comes inpatient. Wow. So there's quite a variety of stuff I get to do there. But in my role, I've been I'm lucky I get to do a lot of piloting different stewardship services within our health system to then see, okay, if it worked here, can we take it elsewhere? So the latest one we've been doing. Yep. Yeah, the latest one we've been doing is a E D culture callback service, which is the E D pharmacist. I'll help support for patients who are discharged with these positive urine cultures, blood cultures, they match to what treatment they received, and then follow up and see if they if a intervention is needed. So there's quite the number of interventions they've gotten to make, but the biggest one lately has been urine cultures because they find a lot of very resistant isolates to where it was like, ah, this is very relevant to the topic today.

SPEAKER_02:

That's perfect, yeah. Well, and it's you know, I always it just always fascinates me uh, you know, how versatile our degree is and all the different things that you can do. You know, like if you would have told me as a student 20-something years ago that there was a special role for an infection antibiotic pharmacist, I would have been like, what? That seems so, you know, like specific and random. So it's just it's so great. I love how we can wear so many different hats with our degree. So well, thanks again for joining me. I really appreciate it. So, like we always like to do to get started is to kind of set the foundation. So, again, as I mentioned, we're gonna be kind of focused on antibiotics and infections today. And so, but let's just talk a little bit about the important roles of pharmacists in this space. So, let's focus a little bit on why is it important for pharmacists to be in infectious disease care? What are some of the important issues there?

SPEAKER_01:

Of course. And I always like to draw this comparison to, you know, I've taken so many law exams recently from from residency training going across these different states and whatnot. But I've always found while there's the law corresponding or like the course, what's the term for it? Corresponding responsibility.

SPEAKER_00:

Yes.

SPEAKER_01:

So, yeah, how a physician may write something, but a pharmacist verifies that legally that's it's valid. I've always found that's the same way when it comes to antibiotics. And that's we see that with the different clinical practice guidelines that have been the basis of our inpatient stewardship programs, is they've always recognized pharmacist expertise. So there's always been in my mind a corresponding responsibility of, hey, you know, someone may say I want to start this antibiotic, but there's always going to be that pharmacist, whether it's inpatient or outpatient. That part of that verification and checking process is is this a is this an infectious disease state that requires the antibiotics? Are there opportunities to watch and wait? Or is there a way to help with identifying, oh, you know what? This dys urea that is the basis of this diagnosis of cystitis, they actually just started a diuretic. Maybe it wasn't a cystitis and it's actually a well intended intended effect or side effect of medications that are medication.

SPEAKER_02:

Yeah, yeah. And and you know, it's it's just it the is the dose appropriate? And you know, is it is the length of therapy appropriate? So there's just so many things. I I love that that connection because it's true just as much as is the is therapy appropriate, you know, because you typically hear when we when we say that corresponding responsibility, it's when we're talking about the scheduled medications and you know, whether or not we should fill those and and you know, is there an appropriate use for it and whatnot? But you're absolutely right. I think that antibiotics are just as important, if not more important, sometimes in that space. So so the term that we hear a lot is antimicrobial stewardship. So remind us what that means, what that entails, and and again, what is kind of the pharmacist's role in that? Because from my perspective, it's it's a bigger role that multiple members of the healthcare team have to be involved with antimicrobial stewardship. But specifically, obviously, we're talking to our pharmacist category here. So what are the what's the specific role and things that pharmacists should do in this space?

SPEAKER_01:

Certainly. And you you kind of hit on some of those, like right dose, right duration. We kind of say it like the five rights, like is what was entered for the right, right disease state, right infectious disease state, because there are some disease states that sound like infections that you really don't need antibiotics for. So first verifying, okay, is this the right indication? Then making sure the dose is right, because depending on the infectious disease type, whether it's a pneumonia or a urinary tract infection, the amount of antibiotic that you need may be different. Yep. And that can that comes into play with that with the efficacy, the safety, cost, especially. Like there are certain very expensive antibiotics in the inpatient, especially in the inpatient setting, where just by knowing, oh, this is a urinary tract infection as opposed to a pneumonia, we use half the dose. And when that drug is dosed at almost$300 per dose, that's a pretty quick cost savings intervention alone, as well as helping the patient not be exposed to as as much antibiotic as they or rephrase that. If the patient doesn't have a compelling indication for that higher dose, then why worse?

SPEAKER_02:

No reason. Yeah, no reason. Yeah. Especially because it could be that it it it worsens side effect profile. And you know, and then are they going to finish the therapy appropriately because they don't like the way it's making them feel? So yeah, there's so many things at play there.

SPEAKER_01:

The other piece I would stress also is the drug interaction piece. If there's anything, the ID physicians that I work with, the hospitalist as well, they really, really lean on pharmacy expertise with the drug drug interaction. It's probably once a week. I at least get a question about I want to do refampin for this patient. Can you screen the list for what or screen their med list? And I know, like any, especially any pharmacy learners right now are probably thinking of like, I keep getting asked these questions, or there's always a test question about refampin. It's because in clinical practice that is such an important drug interaction. And that one is such a potent one that can easily give someone a preventable treatment failure.

SPEAKER_02:

Yeah, yeah, for sure. Yeah. And again, so you know, we see the the same kind of roles for a pharmacist that we see in multiple different practice settings. Again, just being aware, is it the right patient? Is it the right drug? Is it the right dose? Is it, you know, are we have we talked about and thought about the side effect profile and we looked at drug drug and drug disease and drug food interactions? And so it's the same, it's just under the guise of antibiotic stewardship, right? And so it's specifically for those antibiotic medications. So okay, so also I'd be remiss if we didn't mention that the need for continued learning, of course, is important in this space. Um, again, lots of updates to guidelines, as we're going to talk about later, new approvals, new categories of drugs, resistance patterns. I mean, that's a whole nother, that could be a whole different episode in and of itself, is just talking about resistance and you know, how do we, how do we steer clear of that? So, so again, a lot of things that are important. And so it's most important for pharmacists in this space to stay up to date and to take the education that they need. So that's where we come in. So that's why we're trying to give some more information today on a couple of new drugs. So, with that, I think we've laid a good foundation and a good reminder of what the pharmacist overall role is and antibiotic stewardship and the importance of that. So, let's move to digging deep into these new medications. So, specifically, we're gonna try to focus on two medications today that were recently FDA approved, antibiotics. And I'd like for you just to maybe, I don't know if you want to take one at a time. I I I know that they're kind of related, but one at a time, and then we can kind of see, you know, just dig deep into them and and do a deep clinical dive into their the reasoning for them and why they are holding an important place in practice currently. So I'll turn over to you.

SPEAKER_01:

Of course. Yeah. So when I when I first saw these two antibiotics next to each other, my mind went to thank goodness we have other oral options for resistant bacteria, because that is something that is a huge problem of someone has a has an infection with an antibiotic or with a bacteria that has a significant resistance profile, and there's not an oral option there. And normally you hear people go, Oh, that's why we have IV antibiotics. Well, until you follow someone who is on IV antibiotics, especially at home, you start to learn, yikes, IV antibiotics aren't safe. There are all these complications with pick lines, central lines. Like that's one of the most important things that I'm trying to find in an inpatient setting is how do I get these patients out of the hospital with safer if and if there's an available oral option, a safe oral option. Yeah, seeing these two good.

SPEAKER_02:

And I was just gonna say the IV antibiotics are they're just complex in general, like just the whole process. And and again, it's not the typical way that medications are dispensed in in that outpatient setting. And so it's just it's a whole nother complex process and finding finding a pharmacy that can actually fill it and and supply it in the at-home setting and things like that. So yeah, I can understand how that is uh barriers to kind of overcome each time. So yes, that's exciting that they're oral. So I'm I'm glad that I'm glad that they have a a good plus plus off the bat here. So that's great.

SPEAKER_01:

Yep. So looking at these two, so there's PIVA or PEV mesillanum, and then there's Blue Jeppa or Jepotitosin. So these two antibiotics, they're FDA approved for uncomplicated UTIs in women. Now it's when you look at those indications or those those diagnoses, you depending on when you learned about urinary tract infections, over the last few years, there's been a significant change in these diagnoses where even the latest IDSA's complicated UTI infection guidelines, the that new guideline has really stressed that you know what it's uncomplicated and complicated is oversimplifying. Like urinary tract infections are so much on quite the quite the spectrum. So there's we were probably all taught in school complicated urinary tract infections. Like that's a man can't have an uncomplicated urinary tract infection. But like we give macrobid or nitrofurantone to men and have appropriate clinical response. So what I want to caution people with is when they see that label where it says FGA approved for females with U UTI, that does not prevent me from using this in men. In fact, those are probably some of the patients who I'm gonna use this the most in because they have so limited options. Because by the when a male is having these types of urinary tract infections, there's they have quite the resistant stuff because we've they've had so much exposure already. So just because the label says uncomplicated urinary tract infection, those new complicated guidelines had stressed that look, if it's in the bladder, that's a cystitis. If it's gone beyond the bladder, now you have a complicated UTI. So this is where stressing the diagnosis is so so important. Where if a patient has an infection localized to the bladder and it's not gone anywhere else, they don't have a fever, they don't have like flank pain, like this is truly just an infection in the bladder. This is where we're gonna use these two drugs.

SPEAKER_02:

Got it, got it. So they're both used in UTIs, but they are in two different classes, right? Yes. Okay, so let's go ahead and take one, your choice. You get to pick which one you want to start with, and let's just kind of go a deep dive into where it fits. I could probably guess where one of them fits, or both of them actually, just based on their generic name. But but yeah, let's take a deep dive into each of them and just kind of see how they fit into practice. Because if I'm correct, neither of these are like unique or different categories of drugs, right? Or classes of drugs. So they're they're kind of filling into an already crowded venue. So, like, what makes these stand out, other than of course the oral component? So, yeah.

SPEAKER_01:

Certainly. So let's start with the piv micillinum, because what's interesting about this one is this is not a new drug. And in fact, those that can remember some of our older IDSA guidelines have probably seen this drug before, and they probably seem like, oh yeah, I remember seeing this. You can go look at one of those older IDSA guidelines and see PIVMicillin is a recommended option there. But we learned, oh, that's not available in the US, so we can't use this drug right now. So this drug has extensive clinical experience in in Europe. So it's a penicillin class antibiotic. It's but it has quite the ability to withstand some resistance mechanisms. With the one most importantly, is ESBLs, which that is the most common, I would say clinically significant resistance mechanism in gram-negative bacteria. And that's when and when I say that, like a number of uh what we call these the enterbacteralis, so like your E. coli, your proteus mirablis, your klebsiella pneumonia, these are common organisms that we see in urinary tract infections that when we see them start to have an ESBL, they they usually have resistance to other things as well. They usually also have fluoroquinolone resistance. We see we'll see sulfamethox ultramethhoprin resistance. They usually also picked up nitrofreatoin resistance. So there's not a lot of options by the time you see this, these organisms pick up all these resistance mechanisms. So this piv micillinum, it's able, it has activity against these. So it's like, oh, fantastic. Now it's not a drug of choice, pull out the carbapenums. Like there's not, there's not yet oral carbapenems aside from what was it? So solapenum, but the clinical data for that doesn't even look fantastic.

SPEAKER_02:

So interesting. Yeah. So this is entering into, I mean, it's entering into a category where, yes, it's in a class of drugs that is very widely known and has a lot of medications crowded in there with it, but it does have some standout quality. So in addition to the fact that it's an oral medication that does have a standout quality there to help against resistance. So, what I guess one of my questions would be, just because if it's going to be an oral medication, then I'm assuming most of the time it's going to be given in an outpatient setting, right? And so I'm then thinking about the immediate copay structure for a patient and you know how expensive this is. Is this one of those that is that is super expensive and is often hitting the, you know, the PA's, uh, the priorizations and requiring them to be approved and things like that? Or is this something that we're seeing is pretty accessible and easy to get to get and dispense for a patient?

SPEAKER_01:

Great question because these, while they were FDA approved recently, it takes time for drugs come to come to market. I think I saw it was just two months ago. I think it was August when these things finally were commercialized. I haven't seen anybody use it yet. We haven't even talked about it for a formulary decision at our health system.

SPEAKER_02:

Interesting. Okay.

SPEAKER_01:

It is something that I'm going to talk with our culture callback team or culture callback program of hey, instead of having these patients come back to get a single dose of an immunoglycoside, we might be able to call them out an oral treatment to deal with this susceptibility profile. But one of the other challenges with newer antibiotics is not just the availability of it and the commercializing, is that susceptibility piece. So whenever you see that information on a susceptibility report, it usually takes a long time for it to be able to be added on a card or what we call those, like what the microlab runs to get all of your S, I's and Rs. That usually takes a while. So we'll be able to get like those add-on tests, like an e-test or a Kirby Bauer disk diffusion. Um, but those usually take some time also. So what we then run into the question, where this is where I'm kind of at right now, is well, until I know what the what the susceptibility profiles look like, this or the availability to find out that information, it's gonna be hard to find the right patient to use use it in. Got it. Right now, with its FDA approval of if you have cystitis, go ahead and use it. Well, I don't want to use it for someone who's got a an E. coli that I can use all these other antibiotics for.

SPEAKER_02:

Right. So it is, so it is going to be a specialized patient who who has susceptibility to it. It's it's a specific potential resistance, and maybe they've maybe they're allergic to something else. And so this puts them in this category, or they've they've not tolerated another product well, or something like that. So so it sounds like it is, it has a potential great place in practice, but it's maybe not Earth shattering gonna like completely shake up the market, right? Like it's right. Yeah.

SPEAKER_01:

Now, one area I think that I'm really excited for this is because of the decades of experience we have with this antimicrobial in pregnant patients and it being safe, this is gonna be fantastic for them because if you think about a pregnant patient who has a an ESBL producing gram negative, okay, our oral options are we hope we can use a fluoroquinolone, which we do not want to use in pregnant patients. We could use sulfamethoxazol trimethoprim, but depending on where they're at in their in their pregnancy, you can't or can't use that. We like to use nitrofrantorin as much as we can, but whenever you when you have patients who are pregnant, pretty quickly what you're using it's gonna become resistant to because they are just so much more prone to to urinary tract infections. But the complications of a treatment failure are so much worse because an an under-treated urinary tract infection in pregnancy can progress to pylone nephritis, and that can lead to spontaneous abortion. So they so this is gonna be a fantastic. Well, like that's great. Very excited that this will be like once this becomes more available in our health system, I'm finding our OB group and saying, you guys have another toy you get to use that's yeah, that's great, way more efficacious than some of your other options.

SPEAKER_02:

Oh, that's great. Yeah, and especially, you know, some of the ones you were mentioning, you you mentioned sulfur and doxazole. I mean, what if they have a sulfur allergy as well? So you know that one gets ruled out immediately. So yeah, okay, well, that's great. So is there anything else in the the for that medication that you feel like is important to kind of share? Does it stand out in the other way? Is there a specific side effect that is, you know, something that needs to be counseled on, or anything else that's important to kind of share about that medication?

SPEAKER_01:

I'd say two things, and I'll try and be brief on it. First is, and this kind of surprised me, but it makes sense with with the drug, is carnitine deficiency. So if for any reason the patient sh like that needs to be something that needs to be on their radar of I can't, I need to be careful about things that can deplete carnitine, this drug can cause that. So for most people, it's like a transient carnitine deficiency that your body just deals with when the drug is done. But there were a variety of disease states. I can't remember them off the off the top of my head, but that would be a key counseling point I would ask of is there any reason you should be mindful of things that make that deplete your carnitine supply?

SPEAKER_02:

Interesting. And I felt like if if that was asked of a patient, they would probably only know the answer to that if they had a carnitine depletion issue. So yeah, because otherwise they're probably gonna be like, what? I don't know what you're talking about. Exactly. So yeah, if it's something that's been brought up to them before, then obviously it would be something. But yeah, it's a great call out for counseling. Anything else that's nuanced with that drug?

SPEAKER_01:

Yes, and this kind of goes back into the antibiotic stewardship piece of where pharmacy can have a huge role in taking care of your in in antibiotic stewardship and optimizing patient care is this is a penicillin class antibiotic. So if they have a penicillin allergy, your first response should be or your first response is probably, oh, I can't use this. But one of the most important, and this is seriously the what I try and preach in every venue that I have. The most impactful stewardship intervention you can have on a patient is delabeling an inappropriate penicillin allergy.

SPEAKER_02:

Yep, yep.

SPEAKER_01:

It is seriously what I say, 10% of the population have a penicillin allergy, but less than like 1% actually have a real allergy. I see the ramifications of penicillin allergies all the time. So we're trying as a system to proactively delabel these things. There's so much data that shows how harmful it is. But here, you're probably gonna have a patient where they want to use Pivmasillinum, they have a penicillin allergy. That's the opportunity to proactively delabel. And there's a big deeper, yep. Yep. And there's a bunch of different scores out there or tools you can use. So if you're like, how can I delabel these penicillin analogies now? Take a look at Penfast. That is seriously, it's three questions. Takes less than five minutes, and you can figure out who you who is low risk, and you can just play chicken with their allergy to get it delabeled.

SPEAKER_02:

Yeah, and I think that that is important to call out as far as you know, the antimicrobial stewardship role as well, is that that's a cornerstone of it too, is to try to delabel those false allergies. I've always been told that I have an allergy to penicillin and sulfa. I don't necessarily think that that's true, you know? So I would I would love to be delabeled because I feel like that at some point when I was a child, I had some sort of negative, probably GI disturbance from that. And my mom thought that that was an allergy and I shouldn't take it anymore. And so I've always just kind of been labeled with that throughout my life.

SPEAKER_01:

Um based off what you just told me, you have a score of zero or one, and you would be someone that we would challenge. We would say, take this, take this dose of 250 milligrams of ammoxicillin, we'll watch you for an hour. If you have no reactions in an hour, this allergy comes off your chart. And that's a life-saving intervention.

SPEAKER_02:

Like there's data that's because if yeah, because later, if you if you need a penicillin drug because you have a resistant ant bacterial infection to something, then you know you can have it. So yeah, yeah. There you go. Yeah, key thing. I think that we I I I feel like I've had this conversation with someone before. I wonder if it was on a previous episode. Um, but I I remember the whole discussion on delabeling of of incorrect uh allergies that are on people's charts. So yeah, that's that's so important. So thanks for that call out. It's a great, great point. Of course. Okay, so let's switch to jeptotitisin and talk a little bit about where its place is in therapy, maybe some of the nuances for it. Um, again, it's another new antibiotic, a recently FDA approved, and kind of enters a crowded field. But let's hopefully see that it has some silver linings for how it can be utilized.

SPEAKER_01:

So certainly. So Jeppotitisin or Blue Jeppa, that one came out with a little bit lower of an age approval. So while Pivmasillinum is 18 years and older, titosin is 12 years and older. So there's a bit of a there's some PEEDS indicate or PEEDS age included in the in the labeling. This is an exciting new drug. It's not that often we get some first in-class new antimicrobials. It looks and smells like a fluoroquinolone. But when you go and look at the structure, when you go and look at its target site and all that stuff, it's distinct enough to where I'm not gonna call it a like second generation fluoroquinolone. It really is its own class. It does, it does target similar items or it does hit like topar isomerase for those similar targets to fluoroquinolones, but they do it in a novel subunit or in a different spot to where it is able to be used in cases where it's fluoroquinolone resistant, which is really exciting because now if I have those cases where it's fluoroquinolone resistant, it's sulfamethoxyl trimethoprin resistant, I have no oral options, this one likely will have activity against it.

SPEAKER_02:

That's great. So definitely not really joining a class that already exists, it's kind of in a class of its own. So that's it's that's its first checkbox, right? So that's good. And then, like you mentioned earlier, the second key point there is that it is in an oral form. So that's also gonna be proved beneficial in some cases. So, what does it look like as far as are there any side effects, things to look out for, any kind of counseling points there?

SPEAKER_01:

Yeah. So whenever I said it looks and smells like a fluoroquinolone, it's side effect profile. Well, I'm gonna start saying these, and you'll be like, yeah, this sounds like a fluoroquinolone because QTC prolongation is one of the first things that came up on there. Um, I but I want to stress with QTC prolongation, I think this comes up a lot of it's a black and white risk, but it's really a more dose-dependent risk and drug-specific risk. Because I've seen a number of times, even ID physicians I work with, they've said, I can't use ciprofloxicin because it's QT prolonging. So then I have to ask, what is their QTC? And if that number were to increase by three mil milliseconds, would you still use the drug? They go, Oh, yeah, that's fine. So, based off that, it's always there's an actually a really good resource I'll direct the audience to. It's called Casic, K-A-S-I-C. It's this Kentucky Antimicrobial Stewardship Consortium. They have a ton of these clinical pearls, and one of their clinical pearls is about QTC prolongation, and they have this chart that like my whole health system loves. Like they all have this saved now because it lists all these common antimicrobials and to what extent they prolong the. So it's a helpful, yes, exactly. So it's a helpful reference of like, okay, their QTC is 420. And if I give them ciprofloxicin, their QTC goes to four, likely will go to 423. Okay. Wow. Still still in the clear. This is fine.

SPEAKER_02:

It's also well, I was just gonna say it's also the question is other medications that they're on as well, because if the if the metabolism of the medication is delayed, then it's higher dose in the system, right? And so potentially that's a problem. So does it also weigh into effect those things as well?

SPEAKER_01:

Yep. So the and I actually put in a formal drug query, which if people don't realize you can do that, oh, I love doing that because you can get like some very like manufacturer-specific information that you can't find just combing through PubMed quickly. Oh, and I asked, I was like, look, I know it says QTC prolonging, I want to know what the risk is. How how potent is this QTC prolongation? And from what I from the resources they sent me, it was like about 10 to 12 milliseconds. So there are drugs that are even more potent, QTC prolonging, but that's helpful to know. It's 10 to 12 milliseconds with uh with the standard dosing for for a uncomplicated urinary tract infection.

SPEAKER_02:

Yeah, and as you mentioned too, that's important, you know, that's key information. We always talk about, you know, as a pharmacist, when we when we bring up a point of clarification in a collaborative team effort, you know, where we're like, oh, well, you actually could do this or you shouldn't do that. It's always good to have the why or to back it up with the facts. And so it's important to say, instead of just saying, oh no, you can use it, it's I I love the fact that you could say, you can use it because it's actually only going to do this. And, you know, would that be acceptable if that were the case? So yeah, as as I always used to tell my students, if you're going to tell a prescriber that they can't or can or should do something, you better have the facts to back it up, right? You don't just sit there and say, Nope, can't use that. You need to know why. Is there an alternative? Like have a plan. So I love the fact that that kind of gives you more of that plan, more of that buildup and support that you need for that recommendation. So that's That's great. For sure.

SPEAKER_01:

So knowing that piece could be the difference between someone needing IV antibiotics and getting a PIC line place versus, oh, this oral option is an option. And even though it's QT prolonging, they're on all these other meds, I have this recent EKG that says actually we should still be fine even with the anticipated further QT prolonging. Yeah, interesting.

SPEAKER_02:

Okay, so beyond QT prolongation, what else smells like a fluoroquinalong? The G the GI, the GI toxicity and the diarrhea.

SPEAKER_01:

So it's especially when you look at the so the phase three trials, it's the eagle trials. Uh they yeah, the GI toxicity, it's pretty rough. It didn't lead, yeah, it didn't lead to a lot of treatment discontinuation. Like it wasn't this like, oh my gosh, everyone's going to feel so sick with every single dose. But it's definitely something that you'll want to stress in your counseling.

SPEAKER_02:

Got it. Is it is it dose dependent or is it pretty much across the board?

SPEAKER_01:

Like it seems like it's across the board. Got it. I didn't there's so gepotitis is seeking another FDA approval for treatment of some some sexually transmitted infections. So we'll see if there's a different dosing strategy there to see if what the side effect profile is there. But the two key things that stuck out whenever I was looking at this antibiotic was that GI toxicity and that QT prolongation.

SPEAKER_02:

Okay. All right. So no other nuances or counseling points for gepotitisin either.

SPEAKER_01:

I would say one more because if is it a fluoroquidalone-like antibiotic if there's not a laundry list of toxicities to be mindful of. Yes. Um, this was very interesting, and this is likely part of the mechanism for the GI issues, but it is as it acts as an acetylcholinesterase inhibitor.

SPEAKER_00:

Oh.

SPEAKER_01:

So when you think of like cholinergic crisis or like your slud and anti-sLUD, like how you remember all those toxicities, yeah. It it is a reversible acetylcholinesterase inhibitor. So when you think about the toxicities that come with like too much acetylcholine, you're essentially getting that during the time that you're on the treatment. Interesting.

SPEAKER_02:

Okay. And if I'm again, I always like to point out it's been a while since I've been in clinical practice. But if I remember correctly, four quin lones also had that odd, like, was it ligament or something? Oh, yep, the tendon rupture. The tendon rupture, yeah. So did do we see that in this one as well?

SPEAKER_01:

Good question. I did not remember seeing it anywhere in like the common adverse reactions. I was just skimming it also here to see if there was anything in the series. Nope. Okay. I'm sure as there's use, if it's a problem, we may start to see it.

SPEAKER_02:

We may see it, yeah. Because I remember it took a few years for the four quantes to really kind of publish that data and get that out there after lots and lots of use. So yeah. Okay. So then it sounds like these two medications, while new and important, maybe not necessarily like gonna change the game totally for the practice of you know, antibiotics and pharmacy. But but it sounds like they they may have a very comfy seat at the table as far as like getting used for different things. So that's good. Um, so just to kind of reiterate and go back over. So the the first one in the penicillin category, piv piv mistillinam, did I get it right? You got it.

SPEAKER_01:

That's how at least that's how I'll say it. I go to the like I'll go to different ID conferences and I'll hear different experts pronounce it completely different and be like, I don't know if I can change at this point, but got it.

SPEAKER_02:

But so that one, we you know, that was gonna be kind of it's one of its silver linings was potential use in pregnant patients, as well as the fact that it's an oral choice as well. And and then a key call out in that category was just reminding everyone that if you're able to delabel those penicillin allergies, try to do that so that we're not limiting ourselves and being able to use that for some resistance. And then for the Jepatitisin, I'm hearing that it works slightly differently, maybe have some of the side effect profiles, but potentially where there is some resistance for the four quinlones, potentially this one could have a seat at the table because it may work differently enough. And then, of course, what's the any sort of crossover for allergies? So, like if a patient is sulfur or penicillin allergy or anything, like where this would be a choice, obviously as well, it being an oral choice for that as too, right?

SPEAKER_01:

Yep, yeah, with with jepotitis, and even and there's actually some good data out there about for if you have a intolerance to fluoroquinolones that you can use other fluoroquinolones. So if someone has a reaction to Cypro, it's probably fine to use levofloxasin. So I wouldn't really have any reservations if someone has a a fluoroquinolone allergy to using a and when I say allergy, like someone has a rash or they have yeah, yeah, yeah. Yeah, if someone's tendon rupture happens, sure, but then we're not gonna do it.

SPEAKER_02:

Understood. Understood. Okay, that's great. So is there anything else in this space that you wanted to that you had in your notes that you wanted to be sure with that you shared with the listeners before we move on?

SPEAKER_01:

Sure. So two things. One one specific to jepotitisin and then the other one for the management of this disease state. Okay. So for the the other piece for the jepotitisin is there are drug interactions with this. This is a CIP3A4 cleared antibiotic. So going back to the Rafampin example, if for some reason someone's on a 3A4 inducer, you could lead to a treatment failure. And on the opposite side, if someone's on a 3A4 inhibitor, you could have an overexposure or too much or an overexposure of gepotiticin, which especially with its side effect profile, could be bad. Yeah, even more acetylcholinesterase inhibition, even more QT prolongation, even more GI intolerance. Yeah.

SPEAKER_02:

Yeah, yeah, for sure. Okay, so that's key as well. So some great counseling points for both of those, some things to consider. Obviously, as we're the drug experts, it's important that we are aware of those nuances or different things to counsel on. So what so I always say it shocks me every time that we move so quickly and get through so much content. And then I look up and I'm like, wow, time's up. So just to kind of reiterate a little bit of things here, a lot of things that we talked about, but just to kind of unpack again, it's super important for the pharmacist to be in that antimicrobial stewardship space, whether or not that is your actual title, like you have, or whether or not it is just something that you're doing as a good conscientious pharmacist should be doing. So again, making sure we have the right patient, that we're treating the right infection, that we have the right dose, the right length of therapy. And, you know, I think it brings up a good point that we're also on the right form. You know, is it is it oral or is it injectable? You know, like in IV. So just trying to also weigh those pros and cons there too, as well, because cost comes into play, difficulty of access comes into play. Patients, it's just, I mean, it would be scarier for me to know that I have to go home with a pick line and get, you know, IV antibiotics dripped in as opposed to just taking a pill every morning or whatever, you know. So so yeah, I think that that's something to think about too. So just reiterating that, anything else you want to be sure to share from that antimicrobial stewardship point for pharmacist?

SPEAKER_01:

Certainly. So a lot of people think antibiotic stewardship is de-escalating or making sure there's not a bug drug mismatch. But I would say the more patient-specific or what the factors that patients care more about, like can I go home or can I avoid going to the hospital? That opportunity, you are able to make that intervention knowing that about these two antimicrobials. So, and the point I was trying to make earlier with the like knowing the diagnosis between the two, a pharmacist should always feel empowered to ask, okay, a diagnosis of UTI has been made. Is this a located to the bladder, a cystitis, an uncomplicated UTI, or is this a complicated urinary tract infection where it's outside the bladder? If they if a patient is in the outpatient setting, they have a very resistant, say they have a very resistant E. coli, it's an ESBL, it says ceftraxone resistant, it says cipro resistant, it says sulfomethoxal trimethoprin resistant. And they're trying to figure out is there an option other than sending them to the ED or sending them to the hospital to get antibiotics to treat this infection? Knowing the questions to ask, is the diagnosis cystitis or is the diagnosis complicated UTI can help identify the place in therapy of these two antibiotics to help prevent a hospital admission or go visit to the ED to get IV antibiotics.

SPEAKER_02:

Yeah, yeah, that's great. That's a great point. So is there, if you could summarize, like again, our listeners are across many different practice settings. So we have some who are very heavily in the space in patient and see this every day. And then we have some who maybe they don't see a lot of these opportunities for anamacrobial stewardship. Um what would you say is like key thing? Like everyone should do this always, you know. Like, is there anything you could share with listeners for that regard?

SPEAKER_01:

Certainly. Two things. First, everyone should feel comfortable dealing with antibiotic allergies, chiefly penicillin allergy. Second thing, every pharmacist should feel comfortable and empowered to clarify the diagnosis because you can get a treatment failure if you're using the wrong treatment for or the right treatment for well, let me rephrase that. You can't have the right treatment with the wrong diagnosis.

SPEAKER_02:

Got it. Yep. Yeah, key points. That's great. So one thing that I always like to do with our guests before we part is the name of the podcast is Game Changer. So I always like to ask the guest, what is the game changer here? Did we talk about anything that you feel like is gonna change the game? And so what what would be your your take on that?

SPEAKER_01:

I would say that the game-changing aspect of PIDMicillin is we have something that's active against resistant gram-negative bacteria that's been proven pretty safe in pregnant patients. So that's gonna be my that is gonna be my nugget of like, cool, I have something I can offer the OBs now. And for Jepotitisin, the game-changing piece with that is that is another oral antimicrobial that even has a bit younger age option for these really resistant organisms where I can help avoid a hospital admission, an ED visit, avoid Ivy antibiotics. I've got one more option now, which you know, whether you use antibiotics appropriately or inappropriately, you put that pressure on a bacteria, it will learn how to become resistant to it. But now I've got one more option. Well, I guess now two more options in this. In your arsenal.

SPEAKER_02:

Yep, yep. Exactly. That's great. Well, that is all we have time for today, Hunter. This was so good. Thank you so much for your time. It's really great to learn about two new medications in a space that I'm not super familiar with. So I am walking away with tons of great information and good tips. So thank you so much for your time. We really appreciate it. Of course, thanks for having me. Absolutely. If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.