The edition · Infectious Diseases
Vonoprazan-based regimens cleared clarithromycin-resistant H. pylori far more often than PPI regimens
A meta-analysis puts P-CAB eradication at 75% against 53% with PPIs in resistant infection; testing every admitted HIV patient for TB did not beat symptom-guided testing; and an Indian dose-sparing polio vaccine was non-inferior to full-dose IPV on seroconversion.
The edition in brief
In 12 comparative studies of clarithromycin-resistant Helicobacter pylori, regimens built on potassium-competitive acid blockers eradicated infection in 74.7% against 52.7% with proton pump inhibitor regimens (RR 1.42, 1.14 to 1.76); vonoprazan showed the largest effect (RR 1.78). In EXULTANT (published May 2026), 1,172 adults with HIV admitted to hospitals in Tanzania and Mozambique were randomised to universal Xpert Ultra on sputum, stool and urine plus urine LAM, or WHO symptom-guided testing; confirmed TB treated within 72 hours was 16.0% vs 15.3% and eight-week mortality 25.8% vs 28.8% (HR 0.86, 0.69 to 1.07). In Curavivax (May 2026), dihydroartemisinin-piperaquine prevented early P. vivax recurrence where primaquine was delayed (day-42 recurrence 2.4% vs 27.3% with chloroquine). An adjuvanted dose-sparing IPV with about a quarter of the antigen was non-inferior to full-dose IPV in 643 Indian infants for all three poliovirus types. On the regulatory side, the FDA recorded a supplement to Alembic's generic itraconazole application on 14 September; this is an administrative action on an existing generic.
Testing every admitted HIV patient for TB with stool, urine and sputum did not beat symptom-guided testing
In hospitalised adults with HIV, do WHO-recommended TB testing well; universal multi-sample testing did not significantly improve confirmed diagnoses or mortality here.
FDA records a supplement to Alembic's generic itraconazole application
No action is needed; the filing changes nothing about how itraconazole is prescribed.
Dihydroartemisinin-piperaquine prevented early vivax recurrence that chloroquine alone did not
When primaquine cannot be given reliably, chloroquine alone leaves vivax patients open to early relapse; dihydroartemisinin-piperaquine protected better in this Brazilian trial, but Indian guidance still recommends chloroquine plus primaquine.
An Indian dose-sparing polio vaccine was non-inferior to full-dose IPV for seroconversion in infants
An Indian-made dose-sparing IPV produced seroconversion non-inferior to full-dose IPV; nothing changes in the schedule until regulators and the programme adopt it.
Test G6PD before primaquine, and use the result to choose the dose
Before primaquine, check G6PD, exclude pregnancy, and make sure the patient understands all 14 days matter.
P-CAB regimens raised eradication of clarithromycin-resistant H. pylori from 53% to 75%
In areas of high clarithromycin resistance, including much of India, P-CAB regimens such as vonoprazan outperformed PPI regimens in this mixed-design meta-analysis, so consider a P-CAB and confirm eradication.
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