Paul Howard
@paulhoward.bsky.social
Consultant in Palliative Medicine (Isle of Wight, UK); Palliative Care Formulary Editor (neuropharmacology sections)
Really useful summary; thanks
What I'd add is: consider SC B12 replacement. I don't have easy access to MMA, so offer a trial of treatment if fatigued with a B12<350.
Nothing works every time. But can be spectacular: eg
From housebound to going on a holiday
From bedbound to going out for lunch
What I'd add is: consider SC B12 replacement. I don't have easy access to MMA, so offer a trial of treatment if fatigued with a B12<350.
Nothing works every time. But can be spectacular: eg
From housebound to going on a holiday
From bedbound to going out for lunch
November 23, 2025 at 7:45 AM
Really useful summary; thanks
What I'd add is: consider SC B12 replacement. I don't have easy access to MMA, so offer a trial of treatment if fatigued with a B12<350.
Nothing works every time. But can be spectacular: eg
From housebound to going on a holiday
From bedbound to going out for lunch
What I'd add is: consider SC B12 replacement. I don't have easy access to MMA, so offer a trial of treatment if fatigued with a B12<350.
Nothing works every time. But can be spectacular: eg
From housebound to going on a holiday
From bedbound to going out for lunch
Other SC ABx with ph/kin data include: ceftriaxone, ertepenan, meropenam and teicoplanin
SC metronidazole, ceftazidime, pip-taz are all well tolerated
If you're new to SC ABx, this is an excellent review article
pubmed.ncbi.nlm.nih.gov/32674952/
SC metronidazole, ceftazidime, pip-taz are all well tolerated
If you're new to SC ABx, this is an excellent review article
pubmed.ncbi.nlm.nih.gov/32674952/
Subcutaneous Antibiotic Therapy: The Why, How, Which Drugs and When - PubMed
SC administration of antibiotics may be useful in various settings such as in hospitalized patients and among those in long-term care facilities or being cared for at home. However, further clinical studies are needed to assess the pharmacokinetic/pharmacodynamic properties, as well as the risks and …
pubmed.ncbi.nlm.nih.gov
November 15, 2025 at 5:13 PM
Other SC ABx with ph/kin data include: ceftriaxone, ertepenan, meropenam and teicoplanin
SC metronidazole, ceftazidime, pip-taz are all well tolerated
If you're new to SC ABx, this is an excellent review article
pubmed.ncbi.nlm.nih.gov/32674952/
SC metronidazole, ceftazidime, pip-taz are all well tolerated
If you're new to SC ABx, this is an excellent review article
pubmed.ncbi.nlm.nih.gov/32674952/
It also makes parenteral antibiotics more feasible outside of hospitals, ideal for those wanting active treatment, but at risk of harm from hospitalisation (eg those with frailty)
spcare.bmj.com/content/earl...
spcare.bmj.com/content/earl...
Subcutaneous antibiotics in palliative medicine: Retrospective chart review
Objectives To investigate the use and safety of subcutaneous (SC) antibiotics for infection and symptom control in the palliative setting.
Methods We conducted a retrospective chart review of the use...
spcare.bmj.com
November 15, 2025 at 5:13 PM
It also makes parenteral antibiotics more feasible outside of hospitals, ideal for those wanting active treatment, but at risk of harm from hospitalisation (eg those with frailty)
spcare.bmj.com/content/earl...
spcare.bmj.com/content/earl...
I think "the need to recognise dying" is over-emphasised
For me, it's "needing to hear patients and families when they recognise deterioration and are asking for symptom focused care"
(As well as hearing the opposite, when frail people want active escalation; palliation should never be imposed)
For me, it's "needing to hear patients and families when they recognise deterioration and are asking for symptom focused care"
(As well as hearing the opposite, when frail people want active escalation; palliation should never be imposed)
November 14, 2025 at 9:03 PM
I think "the need to recognise dying" is over-emphasised
For me, it's "needing to hear patients and families when they recognise deterioration and are asking for symptom focused care"
(As well as hearing the opposite, when frail people want active escalation; palliation should never be imposed)
For me, it's "needing to hear patients and families when they recognise deterioration and are asking for symptom focused care"
(As well as hearing the opposite, when frail people want active escalation; palliation should never be imposed)
For refractory symptoms, the specialist paramedics take out parecoxib, ketamine, clonidine, lacosamide, phenobarbital etc with our support/advice.
So there really is no excuse for people to die badly for want of access to medicines.
So there really is no excuse for people to die badly for want of access to medicines.
November 14, 2025 at 9:03 PM
For refractory symptoms, the specialist paramedics take out parecoxib, ketamine, clonidine, lacosamide, phenobarbital etc with our support/advice.
So there really is no excuse for people to die badly for want of access to medicines.
So there really is no excuse for people to die badly for want of access to medicines.
It's partly an equity issue: the paramedics are spotting "unplanned" dying as a result of frailty, advanced dementia and other diagnoses whose unpredictable prognoses hampers access to traditional palliative models based on planning ahead. Latter needs supplementing with rapid access approaches
November 14, 2025 at 9:03 PM
It's partly an equity issue: the paramedics are spotting "unplanned" dying as a result of frailty, advanced dementia and other diagnoses whose unpredictable prognoses hampers access to traditional palliative models based on planning ahead. Latter needs supplementing with rapid access approaches
Specialist paramedics from
@iownhs.bsky.social ambulance service identify people in their last days of life wanting symptom focused care, supplement their sch17 ability to give morphine with a PGD for midaz, hyoscine butylbr and levomepromazine, and then call our 24/7 community team to follow-up
@iownhs.bsky.social ambulance service identify people in their last days of life wanting symptom focused care, supplement their sch17 ability to give morphine with a PGD for midaz, hyoscine butylbr and levomepromazine, and then call our 24/7 community team to follow-up
November 14, 2025 at 9:03 PM
Specialist paramedics from
@iownhs.bsky.social ambulance service identify people in their last days of life wanting symptom focused care, supplement their sch17 ability to give morphine with a PGD for midaz, hyoscine butylbr and levomepromazine, and then call our 24/7 community team to follow-up
@iownhs.bsky.social ambulance service identify people in their last days of life wanting symptom focused care, supplement their sch17 ability to give morphine with a PGD for midaz, hyoscine butylbr and levomepromazine, and then call our 24/7 community team to follow-up
Just in case someone's never asked for mycoplasma serology, but isn't sure whether they're missing out, what would you tell them? Esp if they work with immunocompromised people who often have "inflammatory symptoms" (fatigue, sweats, wt loss, anorexia etc)
Asking for a friend.....
Asking for a friend.....
October 12, 2025 at 4:25 PM
Just in case someone's never asked for mycoplasma serology, but isn't sure whether they're missing out, what would you tell them? Esp if they work with immunocompromised people who often have "inflammatory symptoms" (fatigue, sweats, wt loss, anorexia etc)
Asking for a friend.....
Asking for a friend.....
Database studies are prone to streaming; i.e. since apixaban is known to carry a lower bleeding risk, more likely to select it if higher bleed risk - can only control for coded risk factors, so some risk factors missed
So it's interesting that they still found apixaban's non-major bleed risk lower
So it's interesting that they still found apixaban's non-major bleed risk lower
September 28, 2025 at 4:35 PM
Database studies are prone to streaming; i.e. since apixaban is known to carry a lower bleeding risk, more likely to select it if higher bleed risk - can only control for coded risk factors, so some risk factors missed
So it's interesting that they still found apixaban's non-major bleed risk lower
So it's interesting that they still found apixaban's non-major bleed risk lower