The edition · Top Clinical Updates
Seven days of antibiotics matches four weeks in bone infection, and surveillance colonoscopy at five years matches three
Two noninferiority trials shorten long-standing regimens; blinatumomab replacing two chemotherapy cycles lifts four-year event-free survival in high-risk childhood leukaemia by 13 percentage points; a maternal high egg and peanut diet does not prevent infant allergy; and head elevation after thrombectomy remains unproven.
The edition in brief
SOLARIO randomised 500 adults after surgery for orthopaedic infection, all of whom had a local antibiotic carrier implanted, to systemic antibiotics for at least four weeks or no more than seven days. Definite treatment failure at 12 months was 14.1% with the long course and 11.1% with the short one, meeting noninferiority; treatment-related symptoms by week six were 45.2% versus 17.2%. In AIEOP-BFM ALL 2017, 709 children with high-risk B-cell acute lymphoblastic leukaemia were randomised to two cycles of blinatumomab or two cycles of chemotherapy after consolidation: four-year event-free survival was 83.0% versus 70.3% (HR 0.51, 95% CI 0.35-0.73), with treatment-related infection in 23.9% versus 69.4% and neurotoxic events in 12.0% versus 3.2%. PrEggNut randomised 2,137 pregnant women whose babies had a strong family history of allergy to a high or standard egg and peanut diet from before 23 weeks' gestation to four months postnatally; IgE-mediated egg or peanut allergy at one year was 7.8% versus 8.4% (RR 0.93, 95% CI 0.69-1.26). HeadSOAR randomised 1,368 patients in China to 72 hours of head elevation or flat positioning after successful thrombectomy, with no significant difference in 90-day modified Rankin shift (adjusted generalised OR 1.12, 95% CI 0.97-1.29). The edition closes on EPoS II, in which starting surveillance colonoscopy five years after high-risk adenoma removal was noninferior to three years at interim analysis.
Seven days of systemic antibiotics after bone and joint infection surgery matched four weeks or more
After orthopaedic infection surgery with a local antibiotic carrier, seven days of systemic antibiotics is enough — and spares most of the treatment-related harm of four weeks.
Swapping two chemotherapy cycles for blinatumomab lifted four-year event-free survival from 70% to 83% in high-risk childhood leukaemia
In high-risk paediatric B-cell ALL, replacing two chemotherapy cycles with blinatumomab improved four-year event-free survival by about 13 percentage points and cut treatment-related infection to a third.
Eating more egg and peanut in pregnancy did not prevent infant allergy
Advise normal egg and peanut intake in pregnancy; loading the maternal diet does not protect the infant, and the prevention that works happens after birth.
Head elevation after thrombectomy: no significant benefit, but the trial cannot close the question
Head position after successful thrombectomy is not settled — continue local protocol, and do not present flat or elevated positioning to families as evidence-based.
Write a stop date on the antibiotic prescription, not a duration
Prescribe antibiotics with a calendar stop date rather than a number of days; durations drift longer at every handover, dates do not.
Surveillance colonoscopy at five years after high-risk adenoma removal was noninferior to three
For high-risk adenomas as defined here, a first surveillance colonoscopy at five years rather than three is supported — and the released capacity belongs to symptomatic patients.
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