The edition · Infectious Diseases
Adding cefixime to azithromycin did not reduce typhoid treatment failure
A South Asian trial of 1831 patients backs azithromycin alone. Also: a mortality signal for cefepime, carbapenem resistance in Asian hospitals, nirmatrelvir for long COVID, and a Baxter vancomycin recall.
The edition in brief
ACT-South Asia randomised 1847 adults and children with suspected or confirmed uncomplicated typhoid in Nepal, Bangladesh and Pakistan to azithromycin plus cefixime or azithromycin plus placebo for 7 days. Treatment failure was 5.1% in both groups, supporting azithromycin alone. A Bayesian meta-analysis of 110 randomised trials (22,608 patients) found a 94.4% probability that cefepime carries higher mortality than other beta-lactams (OR 1.10), rising to 98.6% in peer-reviewed trials (OR 1.17). ACORN-HAI followed 9496 patients with ventilator-associated pneumonia or hospital bloodstream infection in 41 Asian hospitals: 73.7% of infections involved resistant bacteria, and 28-day mortality was 51.3% with carbapenem-resistant Acinetobacter and 48.4% with carbapenem-resistant Enterobacterales. RECOVER-VITAL found no benefit from 15 or 25 days of nirmatrelvir-ritonavir across cognitive, autonomic or exercise phenotypes of long COVID. The FDA lists a Class II recall of Baxter's premixed vancomycin in dextrose for manufacturing-practice deviations. Today's pearl: write down the planned stop date whenever an antibiotic is started.
Cefepime linked to higher mortality than other beta-lactams across 110 trials
Where an equally suitable beta-lactam is available, prefer it to cefepime, and dose cefepime carefully for renal function when you do use it.
Carbapenem-resistant infections kill about half of patients in Asian hospitals
Treat prevention of ventilator and line infections as mortality control, and involve microbiology early for every carbapenem-resistant isolate.
Nirmatrelvir-ritonavir did not help long COVID in any symptom group
Do not use nirmatrelvir-ritonavir for long COVID; manage symptoms directly.
FDA Class II recall: Baxter premixed vancomycin in dextrose
If your hospital stocks Baxter premixed vancomycin bags, check lots and switch to vial-prepared infusions.
Write the stop date when you start the antibiotic
Every time you start an antibiotic, write the indication and the planned stop date on the chart.
Azithromycin alone is enough for uncomplicated typhoid; adding cefixime did not help
Treat uncomplicated typhoid with azithromycin alone for 7 days; adding cefixime did not reduce failure.
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