drmichaelmarks.bsky.social
NIHR Research Professor
Professor of Medicine at LSHTM.
Lead for Integrated Academic Training at LSHTM.
Consultant in Infectious Diseases at UCLH.
Syphilis & STIs, Neglected Tropical Diseases, Emerging Infectious Diseases, Group A Strep, Pragmatic Trials
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5,418 followers
464 following
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My memory of this area (edge of my actual work) is that no trial has ever shown screening to work - noting that this is not the same as saying screening doesn't work. The UK is currently running a large trial to see if routine screening for GBS is beneficial
www.gbs3trial.ac.uk/health-care-...
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Oncho 150mcg/kg. Safety & PK studies done to 2000mcg/kg. In malaria used 400-600mcg/kg 3 days in a row/month for 3 months. Again not about if works for COVID(which clearly never going to) but many of us in global health use IVM a lot for humans & should not be presented as a drug only for horses.
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Ivermectin is for many things not just horses. ~500 million doses per year for prevention of lymphatic filariasis, onchocerciasis. Best current scabicidal drug we have. We shouldn't talk about it as if it's not a drug for use in humans just because it's not a drug for viruses.
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I think this is a potentially good model. Either discount the fee for people with childcare needs or provide a bursary.
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There wasn't childcare at ECCMID 2024 - I think having childcare is the exception not the rule.
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Good to see but still some barriers. Notably for a conference of this size & cost & which is essentially always during Easter break it remains very disappointing that there is no childcare which creates a barrier for many people to fully participate in the conference.
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Are you not on the mailing list? I'll add you
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Coming to a LSHTM/UCL/UCH/HTD grand round near you soon! Exact date TBC but @seanong.bsky.social has kindly agreed to come and present in more detail in early summer.
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This is distinct from the moral imperative to speak out. But sadly I think for most people it remains true that until directly or closely touched by the issues that it feels like a bad but far away thing. And of course many feel powerless. Maybe time to go and read some Vaclav Havel to be inspired.
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Still a very high-income conference. I would think 90% plus are people focused on & working in high-income settings. Really not a conference where TB, HIV, NTDs get discussed much. Obviously not an excuse but I expect for most people its not (directly) relevant to either their practice or research.
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Yes link at the bottom of the post.
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You mean you think IPC implications of NGS are more actionable than individual clinical management? I can believe that. I think one issue for individual patient Rx is that if someone with sepsis is on very broad Abx then NGS might allow you to narrow Abx (for example) but unlikely improve outcomes.
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Malaria RDTs were good for long time but didn't result in full impact until social science++. NGS clearly brings yield but remains less clear (to me) how translates & whether lack of benefit is mostly a) people dont use data or b) even if they do it doesnt change outcome (or c some combo of above).
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Sure. This particular combination of test & support didn't show impact. Maybe a future combination will. But as above main issue is really don't think showing post hoc data++ was helpful. Process evaluation would have been much more useful in understanding trial.
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Sure "Does this NGS tool & supporting guidance alter outcomes" Answer this trial is no. Not specific to NGS - few new micro tests show clinical outcome benefit in RCT (which doesn't preclude poss broader benefits). My main issue was focus on 2ry & ?? post hoc outcomes despite negative 1ry outcome.
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This was a great session and made a compelling case for studying sex & outcomes in Infectious Diseases trials and studies #ESCMID2025
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Although in some other studies these differences have not been seen pmc.ncbi.nlm.nih.gov/articles/PMC...
At a minimum providing sex differentiated outcome data seems a first start #ESCMID2025
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Wasn't aware that some studies have found higher mortality from SAB in women. Has this been reported elsewhere @steventong.bsky.social @gurujosh.bsky.social @drtoddlee.bsky.social @annalgoodman.bsky.social ?
#ESCMID2025 #IDSky
linkinghub.elsevier.com/retrieve/pii...
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Indeed. My favourite was a letter page of @lrb.co.uk full of letters from readers about some error that had been made in discussing Shakespeare. On same page MRSA was referred to several times as a virus. No letters on this subject appeared.
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Many scientists (& clinicians) are I think borderline unreconstructed logical positivists. Lack knowledge history & philosophy real shame. See same in other direction; glaring lack of basic science knowledge i.e lost track how often @lrb.co.uk make basic errors in if something is virus or bacteria.
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Or indeed some of the classics - Poppers' the Logic of Scientific Discovery or one of my favourites Thomas Kuhn's The Structure of Scientific Revolutions. A shame really how few scientists ever engage with this material and so have very unrealistic perspectives on scientific knowledge creation.
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Possibly although it shouldn't really affect this specific result too much. The main differences in costs here should be related to drug and to management of the AEs associated with them.
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I know @annalgoodman.bsky.social will be presenting at BIA soon and Anna, myself and others are starting to think about UK perspective pieces and translation into practice. There is still a lot of analysis to be done on various aspects to move this forward.
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This type of thing is a central component of a good Target Produce Profile. Blood cultures also difficult cost perspective wise as the additional infrastructure (people to interpret, advise on antibiotics etc) required to make optimal use of them is substantial.
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In the trial we are using 1g TDS as the default. The reality is that in the majority of cases it's an empirical switch because most people don't get positive microbiology for a variety of reasons. @gpollara.bsky.social would probably be able to tell you how the lab calls sensitivity.
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We are using it as our first line agent in the DURATION-UTI trial. There are a few existing trials on its use - mostly in pregnancy as I recall. We reviewed our local data and if making an empiric choice found an equal proportion of isolates susceptible to Cefalexin as Ciprofloxacin.
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Broadly yes. Laurens (the senior author) has done some phenomenal work on subcutaneous dosing of penicillin and how it impacts PK. We are working with him to investigate it in the syphilis space.