Show Notes
Fluoroquinolones (FQs) are valuable given their broad-spectrum activity against Gram-positive and Gram-negative bacteria and their high penetration into various tissues. Yet FQs have also caused concern, with some market withdrawals, important and sometimes long-lasting adverse drug events, and substantial collateral effects on the microbiota. In this episode of Communicable, hosts Emily McDonald and Thomas Tängdén invite Staffan Tevell (Karlstad, Sweden) and Bernadette Young (Oxford, UK) to weigh in on the pro-con debate of FQ use, especially for periprosthetic joint infections (PJIs), which can entail longer treatment durations. They review the standard of care for PJIs, including FQs in combination with rifampicin vs other antibiotic combinations, the impact of the OVIVA trial advocating for early oral switch strategies, the long list of rare but important side effects, and how best to preserve FQs for clinical indications that most need them.
This episode is a follow-up from Tevell and Young’s recently published systematic review of the role of FQs in PJIs [1]. It was edited by Kathryn Hostettler and peer reviewed by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. The executive producer of Communicable is Angela Huttner. References Tevell S, et al. To heal or harm: A systematic review of the role of fluoroquinolones in periprosthetic joint infections. CMI Communications 2025. DOI: 10.1016/j.cmicom.2025.105103 Further reading Mandell LA, et al. Antimicrobial Safety and Tolerability: Differences and Dilemmas. Clin Infect Dis 2001. JSTOR http://www.jstor.org/stable/4461522. Pham TDM, et al. Quinolone antibiotics. Medchemcomm 2019. DOI: 10.1039/c9md00120d. Rodrigues CF and Silva F. The Rise, Fall, and Rethink of (Fluoro)quinolones: A Quick Rundown. Pathogens 2025. DOI: 10.3390/pathogens14060525 Slimings C and Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother 2014. DOI: 10.1093/jac/dkt477 Davis JS, et al. Predictors of treatment success after periprosthetic joint infection: 24-month follow up from a multicenter prospective observational cohort study of 653 patients. Open Forum Infect Dis 2022. DOI: 10.1093/ofid/ofac048. Grossi O, et al. Gram- negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones. J Antimicrob Chemother 2016. DOI: 10.1093/jac/dkw202 Cortes-Penfield NW, et al. Adjunctive rifampin following debridement and implant retention for staphylococcal prosthetic joint infection: is it effective if not combined with a fluoroquinolone? Open Forum Infect Dis 2022. DOI: 10.1093/ofid/ofac582 Pushkin R, et al. A Randomized Study Evaluating Oral Fusidic Acid (CEM-102) in Combination With Oral Rifampin Compared With Standard-of-Care Antibiotics for Treatment of Prosthetic Joint Infections: A Newly Identified Drug-Drug Interaction. Clin Infect Dis 2016. DOI: 10.1093/cid/ciw665 Bock M, et al. Rifampicin reduces plasma concentration of linezolid in patients with infective endocarditis. J Antimicrob Chemother 2023. DOI: 10.1093/jac/dkad316 Zeller V, et al. Influence of the clindamycin administration route on the magnitude of clindamycin-rifampicin interaction: a prospective pharmacokinetic study. Clin Microbiol Infect. 2021. DOI: https://doi.org/10.1016/j.cmi.2021.04.017 Bernard L, et al. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med 2021. DOI: 10.1056/NEJMoa2020198 Vollmer NJ, et al. Safety and Tolerability of Fluoroquinolones in Patients with Staphylococcal Periprosthetic Joint Infections, Clin Infect Dis 2021. DOI 10.1093/cid/ciab145 Gopalakrishnan C, et al. Association of fluoroquinolones with the risk of aortic aneurysm or aortic dissection. JAMA Intern Med 2020. DOI 10.1001/jamainternmed.2020.4199 Li HK, et al. Oral versus Intravenous Antibi
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In this episode of Communicable, hosts Emily McDonald and Marc Bonten are joined by Sylvain Lother and Valentijn Schweitzer for a discussion on the use of macrolides in community-acquired pneumonia. Together, they examine the evidence for adding a macrolide to beta-lactam therapy, which patients may benefit from combination treatment, and how available evidence can inform clinical practice. Resources: AMMI Canada, https://ammi.ca/en/home/ Further reading Postma DF, et al. Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults (CAP-START). NEJM 2015. DOI: 10.1056/NEJMoa1406330 Qian ET, et al. Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: the ACORN Randomized Clinical Trial. JAMA 2023. DOI: 10.1001/jama.2023.20583 Schweitzer VA, et al. Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial. Lancet Infect Dis 2022. DOI: 10.1016/S1473-3099(21)00255-3 van Daalen FV, et al. Management of community-acquired pneumonia in adults: Practice Guideline from The Dutch Working Party on Antibiotic Policy and Dutch Association of Chest Physicians. CMI Comms 2026. DOI: 10.1016/j.cmicom.2026.105206
At the Critical Care Reviews meeting in Belfast in June this year, REMAP-CAP investigators presented results suggesting that oseltamivir may be harmful in critically ill patients with influenza, upending a long-standing clinical practice in intensive care [1]. In this fourth collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Josh Davis are joined by Steve Webb (Monash University), senior REMAP-CAP investigator and 'godfather of adaptive trial design', and Steve Tong (University of Melbourne), esteemed clinical trialist and friend of both podcasts. Together, they walk through the trial domain’s design, outcomes and results, also highlighting how these findings demonstrate the importance and clinical impact of randomised clinical trials. At the time of this episode recording in August, the results discussed were available as a preprint version [1]. Resources REMAP-CAP: A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia, https://www.remapcap.org/ References Murthy S, et al. Oseltamivir for Critically Ill Patients with Influenza: A Randomised Trial. Lancet 2026. Preprint http://dx.doi.org/10.2139/ssrn.7172531
In this episode of Communicable, Emily McDonald and Josh Davis host Henning Bundgaard and Sami El-Dalati for a discussion on early oral antibiotic switch for endocarditis, focusing on the POET trial, led by Bundgaard, and its clinical impact seven years after the results were first published in 2019 [1]. The episode also covers the ‘prose’ and cons of early oral switch therapy, as well as broader challenges of implementing new evidence in practice when it goes against long-standing dogma. References Iversen K, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis, NEJM 2018. DOI: 10.1056/NEJMoa1808312 Further reading: Pries-Heje MM, et al. Five-Year Outcomes of the Partial Oral Treatment of Endocarditis (POET) Trial, NEJM 2022. DOI: 10.1056/NEJMc2114046 El-Dalati S, et al. Partial Oral Versus Intravenous Antibiotic Therapy for Endocarditis With Management by a Multidisciplinary Team: A Retrospective Cohort Study, OFID 2025. DOI: 10.1093/ofid/ofaf625 McDonald EM, et al. Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement, JAMA Netw Open 2023. DOI: 10.1001/jamanetworkopen.2023.26366 European Society of Cardiology (ESC). 2023 ESC Guidelines for the management of endocarditis, 2023.
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