The edition · Infectious Diseases
Shorter antibiotics for endocarditis buy thirteen drug-free days and cost some relapses
POET II shortens left-sided endocarditis therapy safely but with more relapse, post-mortem data from Africa and South Asia put Klebsiella and Acinetobacter at the centre of neonatal sepsis deaths, and nirmatrelvir does nothing for long COVID.
The edition in brief
POET II randomised 508 stabilised adults with left-sided infective endocarditis, already treated for 2 to 4 weeks, to stop antibiotics or complete a standard 4 to 6 week course. The tailored group gained 13 more days alive without antibiotics (95% CI 12 to 13) and met non-inferiority for death, unplanned cardiac surgery or embolic events at 6 months (8.2% versus 10.7%). But relapse of bacteraemia or endocarditis occurred in 5.1% versus 1.6% (p=0.04). Shortening is defensible; it needs a relapse plan attached. CHAMPS examined 2,609 neonatal deaths across seven African and South Asian countries using minimally invasive post-mortem sampling. Infection was in the causal pathway in 44.0%. Gram-negative organisms accounted for 74.1% of infection-related deaths, led by Klebsiella pneumoniae at 41.7% and Acinetobacter baumannii at 25.7%; Group B Streptococcus was only 5.7%. Over 80% were judged avertable. Standard ampicillin-gentamicin does not cover this. Curavivax found dihydroartemisinin-piperaquine markedly outperformed chloroquine for Plasmodium vivax when primaquine was delayed — 2.4% versus 27.3% recurrence at day 42 — while the two were equivalent when primaquine started on day 0. EXULTANT tested expanded, symptom-independent tuberculosis testing in 1,172 hospitalised adults with HIV and found no increase in treatment starts and no mortality reduction. RECOVER-VITAL found nirmatrelvir-ritonavir gave no benefit in long COVID across cognitive, autonomic and exercise phenotypes. Regulatory: a generic fidaxomicin has been approved, which matters for Clostridioides difficile costs. Today's pearl: if you shorten a course, schedule the relapse watch before the patient leaves.
POET II: stopping antibiotics early in stabilised endocarditis is safe, but relapse triples
In a stabilised patient with left-sided endocarditis who has had 2 to 4 weeks of therapy, stopping antibiotics early is safe on hard outcomes but roughly triples relapse — so only do it with follow-up cultures arranged.
What actually kills newborns in South Asia is Klebsiella and Acinetobacter, not Group B Strep
Check that your unit's empirical neonatal sepsis regimen actually covers Klebsiella and Acinetobacter, because those two organisms account for two-thirds of infection-related neonatal deaths in this region.
If you shorten a course, book the relapse watch before the patient leaves
Before stopping any antibiotic course short, arrange the follow-up review and repeat cultures — the trials that justify shortening all had protocolised relapse detection built in.
Curavivax: DHA-piperaquine protects against vivax recurrence when primaquine is delayed
If radical cure with primaquine will be delayed or adherence is doubtful, dihydroartemisinin-piperaquine cuts 42-day vivax recurrence from about 27% to under 3% compared with chloroquine.
Testing everyone with HIV for TB on admission did not save lives
Adding stool and urine Xpert testing to standard symptom-triggered tuberculosis screening in hospitalised patients with HIV did not increase treatment starts or reduce mortality — the WHO algorithm is already catching them.
Nirmatrelvir does not treat long COVID
Prolonged nirmatrelvir-ritonavir gives no benefit in established long COVID across cognitive, autonomic or exercise symptoms — say so plainly when patients ask.
Generic fidaxomicin approved; nothing else new for the desk
Nothing new from the regulators today beyond a generic fidaxomicin approval — worth a formulary re-look if cost was the reason you were not using it for recurrent C difficile.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for infectious diseases, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free