20 May 2025 TI Blog Update: May 2025
In this TI Blog post we announce the publication of the latest issue, 155 (May 2025) of the Therapeutics Letter and invite you to register for a TI Best Evidence Webinar scheduled for Wednesday, June 4th on the topic: oral vs IV antibiotics. We also give you a preview of future Therapeutics Letters and highlight the “SAVE THE DATE” announcement for the 2025 TI Annual Course, scheduled to take place as a virtual (online) event on November 28-29, 2025. If you are a primary care physician or nurse practitioner in BC, we invite you to sign up for the TI Portrait program. And to wrap up this blog post we would like to ask you a favour: please let your colleagues, residents, and students know about the TI and encourage them to subscribe to our notification service.
Today’s posting of Therapeutics Letter 155: Oral vs IV antibiotics reflects the work of Dr. Davie Wong, an infectious disease specialist in British Columbia’s Fraser Health Authority. Like all Therapeutics Letters, it is unsigned because it represents the integrated efforts of our team. For Therapeutics Letter 155, this involved a record number of external expert reviewers in Canada, Switzerland, the United Kingdom, and the United States: 8 specialists in infectious diseases ranging from younger consultants to the most experienced medical scientists, plus emergency medicine and intensive care/general internal medicine, nurse practitioner, family practice, and pharmacy.
Therapeutics Letter 155 concludes that oral antibiotics are as effective as intravenous (IV) antibiotics for most bacterial infections; for stable patients, oral antibiotics should be first-line therapy and IV treatment should be reserved for people who cannot take pills or for infections for which effective oral therapy does not exist; and oral treatment improves patient experience, consumes fewer health system resources, and generates a lower carbon footprint.
We hope that you’ll find Therapeutics Letter 155 an interesting and thought-provoking challenge to many assumptions you may have learned as dogma. On Wednesday, June 4th, 2025 at 12:00 noon Pacific time Dr. Wong will explore these issues further in a TI Best Evidence Webinar.
In this TI Best Evidence Webinar, Dr. Davie Wong will address a historical practice that is often unwarranted, by reviewing evidence from RCTs and comparing the advantages and disadvantages of oral and IV antibiotics. He will suggest criteria to determine when oral therapy is appropriate and will answer questions about this topic.
In June, we expect to post Therapeutics Letter 156, exploring the nature and frequency of antidepressant withdrawal syndromes. Often, these are referred to euphemistically as a “discontinuation syndrome.” A related Therapeutics Letter 157 will follow in July, considering whether some people need to taper an antidepressant much more cautiously (or “hyperbolically”) than others. This builds on a May 2024 very popular TI Best Evidence Webinar featuring Dr. Mark Horowitz that was viewed over 20,000 times. If you missed it, you can watch the recording in the TI YouTube channel.
Working to understand antidepressant withdrawal obliged me to think about whether prescribing an antidepressant should require formal documentation of informed consent from patients. Many now consider this essential for long-term opioid therapy in chronic pain, or before prescribing a benzodiazepine or Z-drug for more than a few days. And what about prescription stimulants or cannabis?
SAVE THE DATE: TI Annual Course 2025
The 2025 edition of the TI Annual Course will be held this year as a virtual (online) event on November 28-29, 2025.
In addition to presentations by our own faculty, we have lined up an impressive group of speakers who will present on the following topics:
- Self-diagnosis and diagnosis of ADHD in adults (Allison Harrison)
- Post-MI preventative treatments (Jamie Falk)
- Treating pain is harder than it looks (David Juurlink)
- Menopause (Ilana Lega)
- Highlights from PAD topics (Cait O’Sullivan)
The TI Annual Course 2025 will have 2 live sessions, one in the afternoon of Friday, November 28 and one in the morning of Saturday, November 29.
Registration will open soon, SAVE THE DATE in your calendar.
If you are a primary care physician or nurse practitioner in BC but don’t know about our Portrait program, maybe you should ask yourself why not. Over 1,000 BC family doctors and nurse practitioners have already signed up for Portrait and are receiving personalized, completely confidential information that can help improve their prescribing practice to serve patients better.
“I found the work of TI incredibly useful during my career, so keep up the good work!”
[P. Aiken, recently retired family physician, Burnaby, BC]
You can learn more about the Portrait project and view samples of completed Portrait topics here: https://www.ti.ubc.ca/portrait/
The Portrait program includes an experimental component (early vs delayed release to subscribed prescribers) to help the TI and others learn effective techniques to improve prescribing that is based on sound medical scientific evidence. In future, pharmacists may be eligible to join. Registration is simple and free: BC family physicians and nurse practitioners can sign up to access confidential prescribing Portraits via our convenient and secure online portal.
Log in to view your Portraits and/or related materials, or sign up if you haven’t already.
Questions? Email the TI Portrait team at portrait@ti.ubc.ca We welcome your feedback.
Over 13,000 people are subscribed to receive email notifications from the TI when new issues of the Therapeutics Letter are posted online, as well as notices of upcoming webinars and other continuing professional development events. Our work is supported by the people of British Columbia through a grant from the BC Ministry of Health.
Yet even in our 31st year as an independent, unconflicted academic group at UBC, many British Columbia clinicians and students don’t seem to know about us. If you value our contribution to unconflicted information about medications, even if you don’t always agree with our conclusions, please consider letting your colleagues, residents, and students know about us. Our work is relevant to medicine, nursing, pharmacy, other health professions and health researchers, and last year we introduced plain language summaries and abstracts to make our Therapeutics Letters more accessible to lay people and the general public. Therapeutics Letters are now abstracted and referenced by PubMed Bookshelf, and the African Journal of Primary Care and Family Medicine has recently begun to publish Therapeutics Letters relevant to African healthcare.
It’s simple to encourage colleagues, students, and friends anywhere in the world to subscribe to the TI notifications, and it’s free, confidential, and easy to unsubscribe. Just share with them the link to our home page: https://ti.ubc.ca and/or the subscription link.
I hope you can find something of interest among the various things we are offering. And we always welcome your comments and suggestions.
Thomas L. Perry MD, FRCPC
Editor, Therapeutics Letter
Therapeutics Initiative
University of British Columbia, Vancouver
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