Premixed vancomycin under recall, and a caesarean antibiotic that took eight years to reach four in ten operations

The edition in brief

The infectious diseases desk today is mostly about delivery rather than discovery. Two ready-to-use vancomycin presentations, in sodium chloride and in dextrose, are under ongoing Class II recall for deviations from current good manufacturing practice. Class II means temporary or reversible harm is possible and serious harm unlikely, so this is a supply and preparation problem rather than a safety signal about vancomycin - but losing the premixed bag moves dilution back to the ward at the moment a septic patient needs the dose. An analysis of 1,663,441 US deliveries measured what happened after 2016 trial evidence that adjunctive azithromycin reduces postpartum infection at unscheduled caesarean. Administration rose from 2.2% to 39.6% of caesarean births, against essentially no change at vaginal birth: a difference-in-differences estimate of 37.6 percentage points (95% CI 33.1 to 42.2). Postpartum infection fell by an adjusted 2.0 percentage points (95% CI -2.6 to -1.4) relative to the vaginal birth trend. Eight years on, six in ten eligible operations still did not receive it. A phase 2 trial of transdermal 17β-estradiol for COVID-19 in Qatar was terminated in June 2022 having enrolled 29 men with mild disease against a much larger target, because vaccination and revised quarantine policy removed the eligible population. It reports tolerability and no thromboembolic events, and no efficacy conclusion is possible. An international trial of antibiotic-impregnated bone graft in hip arthroplasty is recruiting 1100 patients.