The edition · Infectious Diseases
Adding bismuth to amoxicillin-metronidazole lifted H. pylori eradication to about 85% in clarithromycin-resistant infection
A Korean trial finds a better-tolerated rescue for resistant H. pylori. Also: stopping endocarditis antibiotics early on response saved two weeks but tripled relapse, a third of mpox PCR positives in DR Congo were likely environmental DNA, how Pneumosil compares with PCV13, and a generic tigecycline supplement.
The edition in brief
In a Korean multicentre trial in clarithromycin-resistant Helicobacter pylori, adding bismuth to 14 days of PPI, amoxicillin and metronidazole raised eradication from 68.2% to 84.8% (intention to treat), matching classic bismuth quadruple therapy (81.8%) with far less nausea and vomiting (6.8% vs 25.0%). In POET II, 508 stable patients with left-sided endocarditis who stopped antibiotics once they met response criteria had 13 more antibiotic-free days and non-inferior safety, but relapse was 5.1% against 1.6%. In DR Congo, a Bayesian model estimated 35% of mpox PCR positives with Ct below 40 reflected environmental viral DNA; a Ct cut-off below 34 cut this to 5%. Serological data from 716 infants suggested Pneumosil (PCV10 from the Serum Institute of India) protected as well as GSK's PCV10 against shared serotypes and better against 6A and 19A, with differences from PCV13 by serotype. FDA recorded a supplement to Meitheal's generic tigecycline application — administrative, not a new indication.
Endocarditis: stopping antibiotics on clinical response saved two weeks, but relapse tripled
Continue standard-duration therapy for most left-sided endocarditis; a response-tailored stop saved antibiotic days but relapse was three times as common.
About a third of mpox PCR positives in DR Congo were likely environmental DNA, not infection
In a high-transmission setting, treat a weak-positive mpox PCR (high Ct) with caution and confirm with repeat testing and clinical context.
Pneumosil matched GSK's PCV10 on shared serotypes, and covered 6A and 19A better
Pneumosil is a reasonable PCV choice, with serotype-specific trade-offs against PCV13; do not delay vaccination to obtain a particular product.
FDA: supplement to Meitheal's generic tigecycline application
No change to practice: this is an administrative supplement to a generic tigecycline licence.
Test for cure after H. pylori treatment, and stop the PPI first
Confirm H. pylori cure with a breath or stool test at least four weeks after treatment, two weeks off the PPI.
Clarithromycin-resistant H. pylori: add bismuth to amoxicillin-metronidazole
For clarithromycin-resistant H. pylori, add bismuth to a 14-day PPI-amoxicillin-metronidazole regimen; it matched classic quadruple therapy with less nausea.
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