Stopping antibiotics early in endocarditis buys freedom at the cost of relapse

The edition in brief

Four trials today, and each one is a lesson in reading a composite endpoint carefully. POET II randomised 508 adults with left-sided infective endocarditis, already stabilised on 2 to 4 weeks of antibiotics, to stop treatment or complete a standard 4 to 6 week course. The tailored group gained 13 more days alive without antibiotics, and the safety composite of death, unplanned cardiac surgery or embolism was noninferior at 8.2% versus 10.7%. But relapse of bacteraemia or endocarditis rose from 1.6% to 5.1%. The strategy is defensible; the relapse figure has to be part of the consent conversation. A pooled individual-patient analysis of the ABYSS and SMART-DECISION trials, 6,238 patients, tested stopping beta-blockers more than six months after a myocardial infarction in people with an ejection fraction of 40% or above and no heart failure. Discontinuation met noninferiority on both endpoints (primary hazard ratio 1.09, 95% CI 0.97 to 1.24; key secondary 1.01, 95% CI 0.83 to 1.23). The authors themselves flag that the primary composite was hospitalisation-heavy. PRoMPT BOLUS randomised 9,041 children with septic shock to balanced fluid or 0.9% saline across 47 emergency departments. Major adverse kidney events were 3.4% versus 3.0% (risk ratio 1.10, 95% CI 0.88 to 1.40) — no difference, despite hyperchloraemia in 49.0% of the saline group versus 31.4%. ASPIRED found 14-day ambulatory ECG monitoring after unexplained syncope did not reduce recurrent episodes at one year. An updated Annals review puts placebo-subtracted weight loss at 14.8% for subcutaneous semaglutide and 19.0% for tirzepatide. No new regulatory action appeared in today's sweep.