Half the benznidazole dose, half the length, and fewer people stopping it

The edition in brief

TESEO randomised 450 adults in Bolivia with chronic Trypanosoma cruzi infection to six regimens. Benznidazole 150 mg once daily for 30 days achieved sustained parasitological clearance at 36 months in 94% against 95% on the 60-day twice-daily standard, non-inferior at a -9.5 percentage-point margin, while drug-related adverse events fell from 60% to 37% (risk difference -23 points, 95% CI -38 to -7). Most adverse events appeared within 10-14 days whatever the planned duration, which points to idiosyncratic rather than cumulative toxicity. This is phase 2b in one country and one parasite population. A Cochrane review of 87 randomised trials and 22,631 participants put numbers on cold sore treatment. Topical aciclovir shortened healing by 0.88 days (95% CI -1.43 to -0.33, moderate certainty), topical penciclovir by 1.20 days, and oral valaciclovir by 1.05 days. Oral aciclovir showed little or no effect on one small trial. No minimally important difference has been defined for healing time, so whether a day matters is not established. In the BEEHIVE trial, 901 people previously given at least two mRNA doses were randomised to the 2023-2024 protein-based or mRNA XBB.1.5 vaccine. Day-one systemic events were reported by 62.1% on the protein vaccine and 75.7% on the mRNA one (risk difference -13.7%, 95% CI -19.6 to -7.7). Most were mild and both had largely resolved by day six. A Class II recall affects premixed vancomycin bags. A Lancet review argues that endemic infections need disease-specific stratification rather than a single sepsis frame.