The edition · Infectious Diseases
Azithromycin clears the bacteria in preschool wheeze and changes nothing, while seven days of antibiotics holds in bone infection
A futility-stopped trial separates bacterial clearance from clinical benefit in preschool wheezing; the annual evidence review for the 2026-27 respiratory season puts numbers on influenza vaccine effectiveness; a point-of-care mpox platform returns results in under 40 minutes in Ugandan clinics; and SOLARIO shortens systemic therapy after orthopaedic infection surgery to a week.
The edition in brief
The AZ-SWED trial randomised 840 children aged 18 to 59 months presenting to emergency departments with moderate-to-severe wheezing to five days of azithromycin 12 mg/kg or placebo. It was stopped for futility: symptom scores did not differ in either the bacteria-positive or bacteria-negative cohort, despite bacterial clearance of 58.7% with azithromycin against 11.4% with placebo. The annual JAMA evidence review for the 2026-2027 season identified 69 studies and reported influenza vaccine effectiveness against hospitalisation in older adults ranging from 19.0% to 43.0% and against mortality from 29.0% to 65.8%; effectiveness against laboratory-confirmed influenza-associated death in those aged 6 months to 17 years was 80.0% (95% CI 75.0-84.0), and high-dose versus standard-dose vaccine in older adults gave a relative effectiveness against hospitalisation of 43.6%. A self-controlled case series of 9,973,703 people found no increase in serious adverse events including Guillain-Barre syndrome. A field evaluation of the Dragonfly point-of-care molecular platform in 300 patients at six Ugandan facilities showed 98.5% sensitivity and 96.2% specificity for monkeypox virus against qPCR, with results in under 40 minutes. The FDA has approved a supplement to an abbreviated new drug application for generic itraconazole. The edition closes on SOLARIO, in which seven days of systemic antibiotics after orthopaedic infection surgery with a local antibiotic carrier was noninferior to four weeks or more, with far fewer treatment-related symptoms.
Azithromycin cleared the bacteria in wheezing preschoolers and made no difference to their symptoms
Stop adding azithromycin to preschool wheeze; it clears the bacteria and does nothing for the child.
The 2026-27 influenza evidence review: 80% effectiveness against paediatric influenza death, 19-43% against hospitalisation in older adults
Vaccinate older adults for hospitalisation and death rather than for symptom prevention, use the high-dose formulation where available, and coadminister without concern.
A point-of-care mpox platform matched central PCR in Ugandan clinics, in under 40 minutes
Where mpox is suspected and a validated point-of-care molecular test is available, it can support the same-day isolation decision that centralised PCR cannot.
FDA approves a supplement to a generic itraconazole application
No clinical change follows from this approval; the itraconazole work in clinic remains absorption, interactions and adherence.
A positive nasopharyngeal swab in a child is usually carriage, not infection
Decide on antibiotics from the clinical picture; a nasopharyngeal isolate in a child tells you what they carry, not what they have.
Seven days of systemic antibiotics matched four weeks after orthopaedic infection surgery with a local carrier
Where a local antibiotic carrier was implanted at orthopaedic infection surgery, plan seven days of systemic antibiotics, not four weeks.
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