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pjlillie.bsky.social
Patrick Lillie
@pjlillie.bsky.social
2.2K followers 770 following 250 posts
ID doc (TB / haem-onc) bit of research on the side, fell walking when chance allows
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · 20d
Place Fell overlooking Ullswater - it is a great scene
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Sep 11
Agree - being able to tailor regimens to the individual case in front of you from shorter through to longer is key, either with biomarkers / response to treatment
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Sep 9
Quite, there’s a reason many of us extend treatment in severe disease…
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Sep 9
True, but I suppose most of us tend to over treat MDR / XDR TB so unlikely (esp in xdr cases) to not use it if littke eise. And it’s still in the leprosy guidelines
pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Sep 9
Only use it when few other options but there is some evidence

www.medrxiv.org/content/10.1...

www.nejm.org/doi/full/10....
Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis | NEJM
For decades, poor treatment options and low-quality evidence plagued care for patients with rifampin-resistant tuberculosis. The advent of new drugs to treat tuberculosis and enhanced funding now p...
www.nejm.org
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Aug 24
But apart from that, what has doxycycline ever done for us?
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Patrick Lillie @pjlillie.bsky.social · Aug 19
Because you’re not allowed to say cockwomble on TV?
pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Aug 7
Excellent choice UKHSA! Well done Susan and good luck in the new role

www.gov.uk/government/n...
New chief executive appointed at UKHSA
Professor Susan Hopkins is appointed as the new Chief Executive Officer of the UK Health Security Agency (UKHSA).
www.gov.uk
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Aug 4
Final wainwrights completed yesterday evening, 214 fells and 13 yrs in the walking. Need to find another “challenge” to keep me sane(ish)
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Aug 2
Fells 208-211 done, brilliant weather and hopefully get the final 3 in tomorrow before storm Floris arrives
Selfie on Dow Crag View from summit Looking towards Scaffell massif Looking towards the coast from Dow Crag
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Patrick Lillie @pjlillie.bsky.social · Jul 17
Certainly worth trying, worked in some people quite nicely
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jul 16
LP then crack on with induction treatment, then probably long term suppression given the lymphoma isn’t going away
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jul 16
Blood cultures done? Has their lymphoma been treated (and if so with what?) Titre of the crypto antigen? Given their immune status and findings I’d probably get an LP then treat with Ambisome +\- flucytosine (not been able to get it for ages here). Interested to see what people do…
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jul 2
Reasonably extensive disease and previous NTM treatment so will prob do co-trim + Moxi for 4-6 weeks then drop to co-trim if improving. Imipenem mentioned in lots of guidance but it’s awkward to use hence asking about erta / other options
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jul 2
Thanks, as not had any treatment yet and extensive disease on CT I’m prob going to do co-trim and Moxi initially then drop to co-trim mono when improving
pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jul 2
I tend to be cautious with using co-trim and linezolid together over marrow suppression but certainly happy to use linezolid if probs with co-trim
pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jul 2
#IDSky - pulmonary Nocardia (can’t speciate fully, do have MICs) with cavitation and nodules. Pretty well and certainly outpatient. Opat can’t do imipenem. Will have co-trim, would anyone try ertapenem instead of imipenem? Amik and ceftriax MICs high, Moxi is option with lowish MIC
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jul 2
📌
pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jun 25
No Smith playing but it is an encouraging sign
pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jun 18
How long have they had IV so far? If they can tolerate the number of tabs orally then I’d stick at that dose orally with a repeat scan at 4 weeks to see what’s what (assuming undrained abscess)
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jun 13
Yeah, a bio marker / combination that predicts low risk of relapse would be brilliant
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jun 13
Individualising treatment based on response and baseline features seems very sensible (both to shorten and extend treatment). A trial would be great
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Reposted by Patrick Lillie
lanceturtle.bsky.social
Lance Turtle @lanceturtle.bsky.social · Jun 11
JOB OPPORTUNITY:

Come and work with us in the @nihr.bsky.social Health Protection Research Unit in Emerging and Zoonotic Infections @hpruezi.bsky.social. We have a post for a clinician to do a PhD in emerging infections and/or vector borne disease, working on national clinical studies.
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pjlillie.bsky.social
Patrick Lillie @pjlillie.bsky.social · Jun 4
Although I do quite like rifabutin as an option if I can’t get rifampicin combinations
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Patrick Lillie @pjlillie.bsky.social · Jun 4
I’m not sure NHS England would be keen on me dishing out bedaquiline that frequently but agree it’s nice to know the 2nd line drugs are good for “standard” TB
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