WEBVTT 00:00:07.230 --> 00:00:10.210 Thanks for joining us again at the Canadian Breakpoint, 00:00:10.390 --> 00:00:13.529 a Canadian infectious diseases podcast by Canadian 00:00:13.529 --> 00:00:17.129 infectious diseases physicians. I'm Summer Stewart 00:00:17.129 --> 00:00:20.109 here with Dr. Rupina Pirwal, Pediatric Infectious 00:00:20.109 --> 00:00:23.030 Diseases Physician in Saskatoon. For today's 00:00:23.030 --> 00:00:25.929 episode, we welcome back Dr. George Zanell to 00:00:25.929 --> 00:00:29.230 share clear registry results for IV AmoxClab. 00:00:29.690 --> 00:00:33.229 Dr. Pierwal. All right. Welcome, everyone, to 00:00:33.229 --> 00:00:35.270 another episode of our podcast, The Canadian 00:00:35.270 --> 00:00:39.229 Breakpoint. Today, we have Dr. Zanell back with 00:00:39.229 --> 00:00:42.229 us to discuss the CLEAR registry. And as many 00:00:42.229 --> 00:00:45.049 of you know, he's a microbiologist and pharmacologist 00:00:45.049 --> 00:00:47.829 who received his PhD in the Department of Medical 00:00:47.829 --> 00:00:50.409 Microbiology and Infectious Diseases, the Faculty 00:00:50.409 --> 00:00:54.270 of Medicine, University of Manitoba, and a doctor 00:00:54.270 --> 00:00:56.770 of clinical pharmacology at the University of 00:00:56.770 --> 00:01:00.570 Minnesota. the Magna Cum Laude. He's presently 00:01:00.570 --> 00:01:03.229 professor and associate head, Department of Medical 00:01:03.229 --> 00:01:05.650 Microbiology and Infectious Disease, Max Rady 00:01:05.650 --> 00:01:08.730 College of Medicine, and research director of 00:01:08.730 --> 00:01:11.030 the Canadian Antimicrobial Resistance Alliance. 00:01:11.689 --> 00:01:14.569 Dr. Zanel is the founding and chief editor of 00:01:14.569 --> 00:01:18.819 the CAR website. Dr. Zanell has published over 00:01:18.819 --> 00:01:22.519 1 ,200 papers, scientific abstracts and posters, 00:01:22.719 --> 00:01:25.280 and book chapters in the area of treatment and 00:01:25.280 --> 00:01:28.079 prevention of infectious diseases. He's presented 00:01:28.079 --> 00:01:31.280 over 1 ,300 lectures, is an invited speaker to 00:01:31.280 --> 00:01:33.719 international, national, and local meetings. 00:01:34.569 --> 00:01:36.930 speaking on the topics of antimicrobial resistance 00:01:36.930 --> 00:01:39.469 infections, as well as the treatment and prevention 00:01:39.469 --> 00:01:42.209 of infectious diseases in pretty much all over 00:01:42.209 --> 00:01:45.150 the world, in Canada, U .S., Central and South 00:01:45.150 --> 00:01:47.769 America, Western and Eastern Europe, including 00:01:47.769 --> 00:01:50.969 Russia, Australia, Southern and Northern Africa, 00:01:51.549 --> 00:01:54.469 the Middle East, and Asia. He's been extensively 00:01:54.469 --> 00:01:57.189 involved in the treatment guidelines for a variety 00:01:57.189 --> 00:01:59.829 of infections in Canada, the U .S., and internationally. 00:02:01.439 --> 00:02:04.400 Dr. Zanell has received or been nominated for 00:02:04.400 --> 00:02:08.020 more than 110 teaching awards, including the 00:02:08.020 --> 00:02:10.659 Canadian Association for Medical Education Merit 00:02:10.659 --> 00:02:14.719 Teaching Award in 2020. Dr. Zanell is a member 00:02:14.719 --> 00:02:17.199 of the Who's Who in Medical Sciences Education. 00:02:17.620 --> 00:02:21.259 In 2022, he was elected as a fellow of the Canadian 00:02:21.259 --> 00:02:24.500 Academy of Health Sciences in recognition of 00:02:24.500 --> 00:02:27.159 sustained excellence in research and teaching 00:02:27.159 --> 00:02:30.289 within the health sciences. Fellowship in the 00:02:30.289 --> 00:02:32.810 Academy is considered one of the highest honors 00:02:32.810 --> 00:02:35.669 for individuals in the Canadian health sciences 00:02:35.669 --> 00:02:40.810 community. Also in 2022, Dr. Zanella received 00:02:40.810 --> 00:02:44.810 the Dr. Fred Aoki Career Achievement Award in 00:02:44.810 --> 00:02:47.710 recognition of a career of dedication and excellence 00:02:47.710 --> 00:02:50.849 in multiple domains of medical microbiology and 00:02:50.849 --> 00:02:53.870 infectious diseases, including research, education, 00:02:54.210 --> 00:02:56.509 clinical practice, service, and administration. 00:02:57.960 --> 00:03:01.860 Each year since 2022, Web of Science identifies 00:03:01.860 --> 00:03:04.900 Dr. Zanell as one of the world's most influential 00:03:04.900 --> 00:03:09.039 researchers, selected among an elite group recognized 00:03:09.039 --> 00:03:12.939 for exceptional research influence, demonstrated 00:03:12.939 --> 00:03:16.080 by the production of multiple highly cited papers 00:03:16.080 --> 00:03:20.219 that rank in the top 1 % by citations for field 00:03:20.219 --> 00:03:24.280 and year. We have an amazing speaker today, and 00:03:24.280 --> 00:03:28.159 we are talking about one of probably the most 00:03:28.159 --> 00:03:31.180 awaited topics for me, because I wanted to bring 00:03:31.180 --> 00:03:36.000 up IVMOX -CLAV into the Clear Registry, and super 00:03:36.000 --> 00:03:40.159 excited to hear some of the results and analysis 00:03:40.159 --> 00:03:42.919 that you guys have done with the Clear Registry. 00:03:43.319 --> 00:03:45.539 Thank you, Dr. Zanell, for being here today, 00:03:45.680 --> 00:03:48.039 and always taking the time to support the podcast. 00:03:48.889 --> 00:03:51.069 Dr. Repina, for me, it's an honor to be with 00:03:51.069 --> 00:03:54.430 you. I do apologize. My mother sends out these 00:03:54.430 --> 00:03:58.490 prolonged biographies and your listeners have 00:03:58.490 --> 00:04:01.229 to suffer through them. So I apologize for that. 00:04:01.250 --> 00:04:03.930 Hopefully the rest of the podcast will be much 00:04:03.930 --> 00:04:08.000 shorter and clearer. No, we love hearing about 00:04:08.000 --> 00:04:10.419 all of your accomplishments. And honestly, they're 00:04:10.419 --> 00:04:13.400 commendable. So we are just honored to have you 00:04:13.400 --> 00:04:15.439 here. And so I think for some of our listeners, 00:04:15.599 --> 00:04:18.699 they have heard of other Clear Registry episodes 00:04:18.699 --> 00:04:21.899 and tuned in. But for some of them who have not 00:04:21.899 --> 00:04:25.139 or haven't had the chance to yet, can you remind 00:04:25.139 --> 00:04:27.439 our listeners what the Clear Registry is, what 00:04:27.439 --> 00:04:30.360 it does, what does it encompass, and what's the 00:04:30.360 --> 00:04:34.269 ultimate purpose of the registry? CLEAR stands 00:04:34.269 --> 00:04:38.069 for, and it's just spelled C -L -E -A -R, stands 00:04:38.069 --> 00:04:41.889 for the Canadian Leadership on Antimicrobial 00:04:41.889 --> 00:04:45.569 Real Life Usage Registry. And essentially it's 00:04:45.569 --> 00:04:50.459 a voluntary and free. data sharing service. I 00:04:50.459 --> 00:04:55.100 have some 450 clear participants across Canada. 00:04:55.220 --> 00:04:59.339 About half of those are infectious disease microbiology 00:04:59.339 --> 00:05:01.959 specialists and about 50 % of those are clinical 00:05:01.959 --> 00:05:03.959 pharmacists interested in infectious diseases 00:05:03.959 --> 00:05:06.850 and stewardship. And what happens is if Canadian 00:05:06.850 --> 00:05:11.990 clinicians are using new IV antibiotics like 00:05:11.990 --> 00:05:16.009 IV Amox Clav, they teach each other about when, 00:05:16.149 --> 00:05:20.089 how, and why they use these new IV antibiotics 00:05:20.089 --> 00:05:23.569 in the Canadian setting. And all we do is just 00:05:23.569 --> 00:05:27.649 facilitate this. So right now on the CLEAR site, 00:05:27.810 --> 00:05:32.839 we have links. to antibiotics such as IV amoxicillin 00:05:32.839 --> 00:05:35.860 clavulinate. And what happens is all of our participants 00:05:35.860 --> 00:05:38.500 have these links. I send them out every three, 00:05:38.540 --> 00:05:41.819 four months. And the participants who've used 00:05:41.819 --> 00:05:45.139 IV amoxicillin clav, for example, or will use 00:05:45.139 --> 00:05:48.970 it, they can hit one of these links. and 17 questions 00:05:48.970 --> 00:05:51.930 pop up, point and click, point and click, point 00:05:51.930 --> 00:05:54.430 and click. You're done in three minutes. And 00:05:54.430 --> 00:05:57.610 then I share the data. I crunch it and I share 00:05:57.610 --> 00:06:00.230 it with all the CLEAR participants every three 00:06:00.230 --> 00:06:02.430 to four months. So the good news is we're going 00:06:02.430 --> 00:06:07.110 to have another data crunch of IV Amox Clav first 00:06:07.110 --> 00:06:10.029 week of September. So if you're a CLEAR participant, 00:06:10.370 --> 00:06:12.730 you'll get that. If you're not a CLEAR participant, 00:06:12.949 --> 00:06:16.819 it's a great opportunity to join. Awesome. It 00:06:16.819 --> 00:06:19.879 sounds like fantastic work. And we've seen it 00:06:19.879 --> 00:06:22.360 with the other antimicrobials and how much information 00:06:22.360 --> 00:06:25.319 that you've been able to provide Canadian prescribers 00:06:25.319 --> 00:06:28.300 and also international prescribers. So super 00:06:28.300 --> 00:06:30.379 excited to see more of this data come through. 00:06:30.519 --> 00:06:34.040 And so specifically for IVMOX -CLAV, when did 00:06:34.040 --> 00:06:36.220 we start collecting this data and what specific 00:06:36.220 --> 00:06:39.339 data have you collected thus far? We started 00:06:39.339 --> 00:06:44.259 collecting data in June of 2024 for IV Amoxclav, 00:06:44.399 --> 00:06:47.519 and we've collected a whole variety of data of 00:06:47.519 --> 00:06:50.939 why clinicians in Canada use this drug, when 00:06:50.939 --> 00:06:53.439 and for what types of infections and pathogens 00:06:53.439 --> 00:06:56.220 they use the drug, and how they use it in terms 00:06:56.220 --> 00:06:59.480 of dosing and infusion. And we also have very 00:06:59.480 --> 00:07:02.420 good data on safety. Perfect. Yeah, and we're 00:07:02.420 --> 00:07:06.500 going to go right into this and talk about... 00:07:06.939 --> 00:07:10.160 What specific age group then are you seeing most 00:07:10.160 --> 00:07:13.899 often that prescribers are prescribing IV amoxiclav 00:07:13.899 --> 00:07:20.670 and which indications? In terms of age, 5 % of 00:07:20.670 --> 00:07:23.350 all the usage is in pediatrics. And I'd love 00:07:23.350 --> 00:07:25.930 to get more pediatric use because this agent 00:07:25.930 --> 00:07:29.250 is indicated for all ages. And then we have a 00:07:29.250 --> 00:07:33.089 lot of use in patients 65 years of age and older, 00:07:33.290 --> 00:07:38.069 and then patients 18 to 64. So 95 % of the use 00:07:38.069 --> 00:07:44.269 is in adults and 5 % use in children. In terms 00:07:44.269 --> 00:07:48.240 of infections, it's very interesting. use IV 00:07:48.240 --> 00:07:52.139 Amoxclav for both on -label, so infections that 00:07:52.139 --> 00:07:54.660 are covered by Health Canada, but also off -label, 00:07:54.759 --> 00:07:57.300 which is very consistent with the way clinicians 00:07:57.300 --> 00:07:59.720 work. They basically look at, look, I know about 00:07:59.720 --> 00:08:01.899 the drug. It's safe, effective. I'm going to 00:08:01.899 --> 00:08:04.579 use it when I think I need to use it. Our biggest 00:08:04.579 --> 00:08:09.160 use, 23%, is intra -abdominal infections, followed 00:08:09.160 --> 00:08:12.639 by acute bacterial skin and skin structure infections. 00:08:13.779 --> 00:08:18.319 Thereafter, cystitis and pyelonephritis community 00:08:18.319 --> 00:08:23.379 acquired pneumonia is also a big indication as 00:08:23.379 --> 00:08:27.920 well as ear nose and throat infections bone and 00:08:27.920 --> 00:08:31.579 joint infections and also a variety of female 00:08:31.579 --> 00:08:34.799 genital type infections so it's used all over 00:08:34.799 --> 00:08:39.100 a whole variety of infections okay and are you 00:08:39.100 --> 00:08:43.259 looking at the the status of the patient. So 00:08:43.259 --> 00:08:46.519 are they admitted to the ward? Are they in the 00:08:46.519 --> 00:08:50.519 ICU? Are they very ill? Are you able to see some 00:08:50.519 --> 00:08:53.330 of that prescriber information as well? Yes, 00:08:53.330 --> 00:08:57.129 we are. So in terms of bacteremia, only about 00:08:57.129 --> 00:09:00.929 19 % of the patients have bacteremia when they're 00:09:00.929 --> 00:09:04.029 being treated with IV amoxclav, and only about 00:09:04.029 --> 00:09:06.909 11 % are in the unit. So the majority of these 00:09:06.909 --> 00:09:10.309 patients are on the medical ward, surgical ward, 00:09:10.429 --> 00:09:14.090 or in the emergency room. Not many are critically 00:09:14.090 --> 00:09:17.919 ill. Interestingly, About 50 % of the time it's 00:09:17.919 --> 00:09:21.460 used as directed therapy where clinicians actually 00:09:21.460 --> 00:09:25.179 identify and culture a pathogen, whether it's 00:09:25.179 --> 00:09:29.080 a staph or a strep or E. coli or proteus or other 00:09:29.080 --> 00:09:32.120 organisms. And the other 50 % of the time it's 00:09:32.120 --> 00:09:34.899 used empiric. Clinicians don't really know what 00:09:34.899 --> 00:09:36.879 the pathogen is yet, but they have a pretty good 00:09:36.879 --> 00:09:40.399 idea based on the infection that they are treating. 00:09:41.549 --> 00:09:45.649 50 % directed, 50 % empiric use. Okay. Yeah. 00:09:45.710 --> 00:09:48.149 And then for the directed use, what's kind of 00:09:48.149 --> 00:09:52.029 the number one pathogen that was identified that 00:09:52.029 --> 00:09:55.129 it was used towards? Was it mainly E. coli? So 00:09:55.129 --> 00:09:59.750 50 % of the time, no pathogen was identified. 00:10:00.830 --> 00:10:04.330 And the drug was used in 26 % of the time. It 00:10:04.330 --> 00:10:06.529 was actually a mixed infection, a combination 00:10:06.529 --> 00:10:10.370 of E. coli or another gram negative and another 00:10:10.370 --> 00:10:13.769 gram positive or even an anaerobe. And then the 00:10:13.769 --> 00:10:18.220 other 25 % organisms grew out, E. coli. streptococci, 00:10:18.440 --> 00:10:22.460 klebsiella, enterococcus, staphylococci, or potentially 00:10:22.460 --> 00:10:25.299 even an anaerobe. So the majority of the time, 00:10:25.320 --> 00:10:28.740 patients are IVM, OX, CLAV, they don't have an 00:10:28.740 --> 00:10:31.580 identified pathogen. The treatment is simply 00:10:31.580 --> 00:10:34.960 empiric, but in a significant chunk, it's a mixed 00:10:34.960 --> 00:10:38.039 infection, mixed gram positives and gram negatives, 00:10:38.059 --> 00:10:41.340 or potentially even an anaerobe. Right. And you 00:10:41.340 --> 00:10:43.539 mentioned like intra -abdominal infections being 00:10:43.539 --> 00:10:46.419 kind of one of the common uses. And obviously, 00:10:46.480 --> 00:10:49.179 as clinicians, we know that those are usually 00:10:49.179 --> 00:10:51.860 polymicrobial infections. And so that's kind 00:10:51.860 --> 00:10:54.580 of the comfort with using the Aviumox Cloud because 00:10:54.580 --> 00:10:58.720 of its broad range of coverage. In terms of the 00:10:58.720 --> 00:11:01.120 providers, is there a specific dose? Because 00:11:01.120 --> 00:11:05.080 I know that in pediatrics, there is kind of a 00:11:05.080 --> 00:11:07.879 standard IV dose and then there's also a higher 00:11:07.879 --> 00:11:10.580 IV dose that you can use. And so I don't know 00:11:10.580 --> 00:11:13.120 if that's been looked at or is it mainly kind 00:11:13.120 --> 00:11:14.720 of the adult information because the majority 00:11:14.720 --> 00:11:18.559 of the participants have registered kind of adult 00:11:18.559 --> 00:11:22.860 use. Is there a specific dose that you've seen 00:11:22.860 --> 00:11:25.620 that providers have been using? Yes, so we've 00:11:25.620 --> 00:11:29.860 captured dosing and also renal function. All 00:11:29.860 --> 00:11:31.940 of these patients have had their renal function 00:11:31.940 --> 00:11:34.659 assessed and dosing has been based on a combination 00:11:34.659 --> 00:11:38.100 of infection, severity of illness, but also renal 00:11:38.100 --> 00:11:43.779 function. By far the most common dose is 1 ,000 00:11:43.779 --> 00:11:49.279 slash 200 milligrams Q8H. The 1 ,000 is the amoxicillin, 00:11:49.279 --> 00:11:53.169 200 is the clavulinate every eight hours. And 00:11:53.169 --> 00:11:55.789 then two other doses that seem to be quite common 00:11:55.789 --> 00:12:03.710 are 2000 slash 200 Q8, as well as 500 slash 100 00:12:03.710 --> 00:12:06.690 Q12. And again, that's based on renal function. 00:12:06.769 --> 00:12:10.049 But by far the most common dose is 1000 milligrams 00:12:10.049 --> 00:12:14.950 slash 200 every eight hours. Okay. All right. 00:12:15.070 --> 00:12:18.649 And then in terms of once prescribers are using 00:12:18.649 --> 00:12:22.269 this in terms of therapy, is it often used as 00:12:22.269 --> 00:12:26.149 monotherapy or combination therapy? By far, 84 00:12:26.149 --> 00:12:30.870 % of the time it's used alone. When it is used 00:12:30.870 --> 00:12:33.230 in combination, it's used in combination with 00:12:33.230 --> 00:12:36.429 a whole variety of different agents because of 00:12:36.429 --> 00:12:38.570 the different infections that are being used. 00:12:38.669 --> 00:12:41.809 But frequently it's used along with vancomycin. 00:12:42.360 --> 00:12:44.759 or a fluoroquinolone, such as ciprofloxacin or 00:12:44.759 --> 00:12:48.179 levofloxacin, or with a macrolide, azithromycin, 00:12:48.320 --> 00:12:51.860 or doxycycline. But the majority of the time, 00:12:51.879 --> 00:12:55.480 it is used alone. All right. And then in my experience, 00:12:55.659 --> 00:13:00.600 I've used it and not had any specific adverse 00:13:00.600 --> 00:13:03.220 events that were severe. And so is that kind 00:13:03.220 --> 00:13:05.860 of what you're seeing in the registry as well? 00:13:05.899 --> 00:13:08.600 Or are there any specific side effects that should 00:13:08.600 --> 00:13:11.480 be brought to our attention? As expected, you 00:13:11.480 --> 00:13:15.200 know, we've had hundreds and hundreds of patient 00:13:15.200 --> 00:13:19.220 cases reported now, and overwhelmingly, the drug 00:13:19.220 --> 00:13:22.759 is unbelievably safe. In 98%, we've just had 00:13:22.759 --> 00:13:26.240 no side effects reported whatsoever. Sometimes 00:13:26.240 --> 00:13:28.600 the clinician doesn't know if any side effects 00:13:28.600 --> 00:13:31.220 have occurred, but overwhelmingly, 98 % of the 00:13:31.220 --> 00:13:34.220 time, no side effects. We had two side effects 00:13:34.220 --> 00:13:38.210 reported. One was rash. The other was a transient 00:13:38.210 --> 00:13:40.529 leukopenia. But I'll say that neither one of 00:13:40.529 --> 00:13:44.129 these two resulted in drug discontinuation. So, 00:13:44.210 --> 00:13:47.110 you know, no surprise. It's a beta -lactam. It's 00:13:47.110 --> 00:13:49.730 a penicillin. This is an astonishingly safe drug. 00:13:50.409 --> 00:13:53.549 Sounds fantastic. So in terms of obviously all 00:13:53.549 --> 00:13:55.750 the clinicians and pharmacists out there and 00:13:55.750 --> 00:13:57.789 nurses are thinking, so what are the outcomes 00:13:57.789 --> 00:14:01.129 in our patients? I know that clear looks at microbiological 00:14:01.129 --> 00:14:04.490 curates and then also clinical outcomes. And 00:14:04.490 --> 00:14:07.690 so what have you seen with IVM Oxclav? So I'm 00:14:07.690 --> 00:14:10.009 going to talk about both the microbiological 00:14:10.009 --> 00:14:12.690 success and the clinical success. But it's very 00:14:12.690 --> 00:14:14.610 interesting. And I think your listeners will 00:14:14.610 --> 00:14:17.610 be interested. You know, why? Why are clinicians 00:14:17.610 --> 00:14:21.299 choosing IVM Oxclav? This is an antimicrobial 00:14:21.299 --> 00:14:24.019 stewardship play, I think, in most hospitals. 00:14:24.600 --> 00:14:28.740 40 % of the time, they're using it instead of 00:14:28.740 --> 00:14:31.379 piperacillin -tazobactam. They're choosing the 00:14:31.379 --> 00:14:34.519 narrower spectrum. 15 % of the time, they're 00:14:34.519 --> 00:14:38.320 using it instead of ceftriaxone. They're using 00:14:38.320 --> 00:14:41.750 it instead of... meropenem and ertapenem. They're 00:14:41.750 --> 00:14:45.730 using it instead of other antimicrobials, such 00:14:45.730 --> 00:14:49.590 as fluoroquinolone. So large part of its use 00:14:49.590 --> 00:14:53.149 is an antimicrobial stewardship strategy. Use 00:14:53.149 --> 00:14:56.190 it instead of things like peptazo, ceftriaxone, 00:14:56.210 --> 00:14:59.730 a carbapenem, a fluoroquinolone, which is wonderful 00:14:59.730 --> 00:15:02.470 in terms of trying to preserve drugs such as 00:15:02.470 --> 00:15:05.710 piperacillin, tezobactam for the future. Now, 00:15:05.730 --> 00:15:08.710 in terms of microbiological outcomes and clinics, 00:15:08.809 --> 00:15:12.049 outcomes. The data is overwhelmingly supportive. 00:15:12.909 --> 00:15:15.730 Microbiological success, which is what we call 00:15:15.730 --> 00:15:19.049 eradication of the pathogen or presumed eradication. 00:15:19.190 --> 00:15:21.629 As you know, Dr. Rupina, I'm a microbiologist. 00:15:21.690 --> 00:15:25.029 I like to kill bugs and moxclav, no surprise, 00:15:25.330 --> 00:15:28.990 you know, it's killing them. 87 % microbiological 00:15:28.990 --> 00:15:31.970 success, meaning the pathogen has been eradicated 00:15:31.970 --> 00:15:34.889 or it can't be found after treatment, which is 00:15:34.889 --> 00:15:38.039 really great news. And in terms of clinical outcomes, 00:15:38.279 --> 00:15:39.940 you know, you're very interested in making patients 00:15:39.940 --> 00:15:43.759 clinically better. 87 % clinical success based 00:15:43.759 --> 00:15:48.460 on either improvement or clinical cure. So, you 00:15:48.460 --> 00:15:51.399 know, wonderful news regarding safety, but also 00:15:51.399 --> 00:15:55.049 very, very good news in terms of efficacy. Yeah. 00:15:55.149 --> 00:15:57.090 And like you mentioned, it gives us an alternative 00:15:57.090 --> 00:15:59.409 option, right? So sometimes when you don't want 00:15:59.409 --> 00:16:01.250 to use Piptase or you don't feel like there's 00:16:01.250 --> 00:16:04.149 a need to use it, you have another option. And 00:16:04.149 --> 00:16:06.710 I think when IV, the formulation came out, because 00:16:06.710 --> 00:16:08.830 I think oral Amoxiclav, everyone's been using 00:16:08.830 --> 00:16:10.809 for a long time. And then when the IV formulation 00:16:10.809 --> 00:16:15.750 was released, I think a lot of us benefited from 00:16:15.750 --> 00:16:17.990 that from both like an antimicrobial resistance 00:16:17.990 --> 00:16:20.269 standpoint, stewardship standpoint, like you 00:16:20.269 --> 00:16:23.409 mentioned, but just awesome clinical curates. 00:16:24.169 --> 00:16:28.830 also patient compliance, and then, and just patient 00:16:28.830 --> 00:16:31.830 satisfaction as well, because it's that one drug 00:16:31.830 --> 00:16:34.230 kind of method. And oftentimes, you know, for 00:16:34.230 --> 00:16:36.629 intra intra abdominal infections, we sometimes 00:16:36.629 --> 00:16:39.690 have to use combination therapy, we're using 00:16:39.690 --> 00:16:41.950 like ceftriaxone, because we need better anaerobic 00:16:41.950 --> 00:16:46.049 coverage with that and, and or even with ciprofloxacin 00:16:46.049 --> 00:16:49.169 sometimes. And so I think IV amoxiclav has really 00:16:49.169 --> 00:16:52.950 helped with patient satisfaction as well, because 00:16:53.389 --> 00:16:55.090 You can present to them that, you know, it's 00:16:55.090 --> 00:16:58.889 a single three times a day medication that we 00:16:58.889 --> 00:17:00.889 can give through your IV. And so they can go, 00:17:01.009 --> 00:17:02.909 especially for pediatric patients who want to 00:17:02.909 --> 00:17:05.390 go on passes in between antibiotics, it really 00:17:05.390 --> 00:17:09.589 helps. So, you know, you talked about oral amoxicillin 00:17:09.589 --> 00:17:11.609 clavulate, which has been available in Canada 00:17:11.609 --> 00:17:14.950 since the 80s. And just so your listeners know 00:17:14.950 --> 00:17:18.930 how old I am, I published a paper on... oral 00:17:18.930 --> 00:17:23.650 amoxicillin clavulinate back in 1986 dr rupina 00:17:23.650 --> 00:17:26.690 so your listeners are listening to a dinosaur 00:17:26.690 --> 00:17:29.549 talking about this drug but you know we we've 00:17:29.549 --> 00:17:32.250 been trying to get the intravenous version to 00:17:32.250 --> 00:17:34.769 canada for many many years because it's been 00:17:34.769 --> 00:17:37.049 available in many countries such as france for 00:17:37.049 --> 00:17:39.509 many many years and we're delighted to have it 00:17:39.509 --> 00:17:43.029 here because 15 of the time clinicians want to 00:17:43.029 --> 00:17:45.509 use a mox club but they want to use the iv and 00:17:45.509 --> 00:17:47.670 that's the reason why they're using it is look 00:17:47.670 --> 00:17:50.039 i I really want to use this drug, but I need 00:17:50.039 --> 00:17:53.440 the IV. Patients can't take oral. So it's wonderful 00:17:53.440 --> 00:17:56.240 we have this drug in Canada. Yeah, it's fantastic. 00:17:56.480 --> 00:17:59.559 And we have information analysis of how it works 00:17:59.559 --> 00:18:02.180 and side effect profiling because of a clear 00:18:02.180 --> 00:18:06.500 registry. So I think it helps prescribers. So 00:18:06.500 --> 00:18:08.900 moving on to any specific resources, obviously 00:18:08.900 --> 00:18:11.920 they have clear registry data and information. 00:18:11.960 --> 00:18:15.720 Are there any publications and posters that our 00:18:15.720 --> 00:18:20.059 prescribers can review or present locally to 00:18:20.059 --> 00:18:24.660 their centers if anyone has any questions? So 00:18:24.660 --> 00:18:29.400 we had a poster in Calgary in April at the AMI 00:18:29.400 --> 00:18:31.420 meeting. That's the Canadian Infectious Disease 00:18:31.420 --> 00:18:35.380 Microbiology meeting. And reviewer and your listeners 00:18:35.380 --> 00:18:39.160 can look at that poster. But I also want to throw 00:18:39.160 --> 00:18:40.799 out a pitch. You know, if you're not a clear 00:18:40.799 --> 00:18:43.059 participant, just send me an email. You know, 00:18:43.079 --> 00:18:45.519 Google George Zanell. You'll find my email address. 00:18:46.619 --> 00:18:49.460 If you've got a pen and you can write it down, 00:18:49.559 --> 00:18:54.079 it's G -G -Z -N -E -L, Z -H -A -N -E -L, at P 00:18:54.079 --> 00:18:58.460 -C -S, internet, all one word, dot C -A. You 00:18:58.460 --> 00:19:00.279 can just send me an email and you become a clear 00:19:00.279 --> 00:19:03.859 participant for free. And it's voluntary. We're 00:19:03.859 --> 00:19:06.380 going to be doing a data cut this September, 00:19:06.660 --> 00:19:10.640 probably in the first week of September. So in 00:19:10.640 --> 00:19:13.400 two through weeks, I'll send out the most current 00:19:13.400 --> 00:19:16.819 data of IBMog's cloud. And if you're a CLEAR 00:19:16.819 --> 00:19:20.640 participant, hit that link. Let us know how things 00:19:20.640 --> 00:19:22.799 work for you when you use the drug. And if you 00:19:22.799 --> 00:19:26.680 just joined CLEAR, I will send you all the data 00:19:26.680 --> 00:19:30.079 come the middle, late September. So if you're 00:19:30.079 --> 00:19:31.920 not a member, join and you'll get the latest 00:19:31.920 --> 00:19:35.299 data on IV Amoxicolab. Awesome. Sounds fantastic. 00:19:35.920 --> 00:19:37.980 And then in terms of how long we're collecting 00:19:37.980 --> 00:19:41.359 this information for IV amoxicillin in the clear 00:19:41.359 --> 00:19:45.759 registry, should prescribers continue submitting 00:19:45.759 --> 00:19:49.039 the data up to a certain date? Are you planning 00:19:49.039 --> 00:19:51.660 on doing some long -term work with this? So thanks 00:19:51.660 --> 00:19:55.160 for this. I see each of these new IV antimicrobials 00:19:55.160 --> 00:19:57.680 being on the clear registry for about three years. 00:19:57.859 --> 00:20:02.019 So as of today, we have intravenous Dalba -Vansin. 00:20:03.740 --> 00:20:07.220 intravenous meropenem, they bore back dam, and 00:20:07.220 --> 00:20:10.700 also intravenous ceftobiprol, but only if you're 00:20:10.700 --> 00:20:13.480 treating endocarditis, of course, along with 00:20:13.480 --> 00:20:17.019 IV amoxclav. And I see each of these drugs being 00:20:17.019 --> 00:20:19.059 on the clear registry for about three years, 00:20:19.140 --> 00:20:22.920 where We send enough data to all the Canadian 00:20:22.920 --> 00:20:27.119 clinicians, show enough AMI posters, publish 00:20:27.119 --> 00:20:29.680 enough papers so that Canadian clinicians feel 00:20:29.680 --> 00:20:32.759 very comfortable with this drug. Where are we 00:20:32.759 --> 00:20:36.259 with IV Amoxclav in this cycle? We're about a 00:20:36.259 --> 00:20:38.539 year and a half in. I'd like to get a lot more 00:20:38.539 --> 00:20:42.140 data. before Christmas of this year, put together 00:20:42.140 --> 00:20:44.779 another AMI poster, which will be presented in 00:20:44.779 --> 00:20:48.619 St. John's in 2026. Then we'll also put together 00:20:48.619 --> 00:20:54.180 a paper and the most common contributors to the 00:20:54.180 --> 00:20:58.599 IVM Oxclav site will be invited to be authors 00:20:58.599 --> 00:21:02.039 like they are on the AMI poster. So I'm hopeful 00:21:02.039 --> 00:21:05.500 that we would continue. gathering data for IV 00:21:05.500 --> 00:21:07.960 amoxiclav for at least another year and a half. 00:21:08.140 --> 00:21:10.839 But my big goal now is between now and Christmas, 00:21:10.960 --> 00:21:14.160 trying to really ramp up lots of data and especially 00:21:14.160 --> 00:21:17.059 pediatric data if clinicians are using the drug 00:21:17.059 --> 00:21:20.420 in children. Awesome. Sounds fantastic. So we 00:21:20.420 --> 00:21:23.299 will all submit our cases and get some more information 00:21:23.299 --> 00:21:27.259 on IV amoxiclav. I think it's been in my practice. 00:21:27.299 --> 00:21:30.339 I use it all the time and I'm excited to see 00:21:30.339 --> 00:21:32.299 what other prescribers are doing across the nation. 00:21:32.759 --> 00:21:34.680 So thank you so much for this wealth of information. 00:21:34.839 --> 00:21:36.819 Is there anything else that you'd want our listeners 00:21:36.819 --> 00:21:40.660 to know about the Clear Registry or about IBM 00:21:40.660 --> 00:21:43.759 Ox Club in general? Dr. Rupin, I think just two 00:21:43.759 --> 00:21:46.660 thank yous. One to you for this wonderful podcast 00:21:46.660 --> 00:21:50.369 series that you put together. And two is for 00:21:50.369 --> 00:21:53.230 all the clear participants. Thank you for all 00:21:53.230 --> 00:21:55.670 of the individuals across Canada, all the clinicians 00:21:55.670 --> 00:21:58.829 who are part of the site. They follow it. And 00:21:58.829 --> 00:22:00.549 thank you to the ones who actually click the 00:22:00.549 --> 00:22:02.750 links and enter the data so we can all teach 00:22:02.750 --> 00:22:05.049 each other. So a couple of thank yous to go around. 00:22:05.720 --> 00:22:07.940 Awesome. Thanks so much. We really appreciate 00:22:07.940 --> 00:22:11.059 you taking the time to come on the podcast. You've 00:22:11.059 --> 00:22:13.680 done several episodes for us and all of them 00:22:13.680 --> 00:22:18.880 have had so much listener love and we're super 00:22:18.880 --> 00:22:22.579 excited to hear more about this and maybe we 00:22:22.579 --> 00:22:25.740 can do an updated episode when you get some more 00:22:25.740 --> 00:22:28.480 information in the next year and a half here. 00:22:28.700 --> 00:22:31.200 Thank you so much. It's been my pleasure. Thanks. 00:22:32.359 --> 00:22:35.049 Thank you, Dr. Zanell, for joining us. Please 00:22:35.049 --> 00:22:37.289 see the episode description for Dr. Zanell's 00:22:37.289 --> 00:22:39.789 email if you'd like to be included on the Clear 00:22:39.789 --> 00:22:42.910 Registry. Be sure to follow us at cabreakpoint 00:22:42.910 --> 00:22:45.509 on X if you haven't already, and we'll see you 00:22:45.509 --> 00:22:47.490 again soon at the Canadian Breakpoint.