Shorter courses and simpler regimens across infection

The edition in brief

A proof-of-concept phase 2b/c trial in South Africa tested a four-month oral regimen of quabodepistat, delamanid and bedaquiline against six months of standard therapy for drug-susceptible pulmonary tuberculosis. End-of-treatment sputum culture conversion was 96.0% with the pooled regimen versus 100% with standard care, meeting non-inferiority (difference −4.0%, 80% CI −7.4 to 3.4), though grade 3 or higher adverse events were more frequent. The endpoint is a surrogate and the trial small, so this supports further study rather than a change of practice. BPZE1, an intranasal live-attenuated pertussis vaccine, raised nasal secretory IgA about 3.5–3.8-fold in a phase 2b trial of 366 children aged 6–17 without interfering with Tdap and with good tolerability — an immunogenicity result, not yet evidence of protection. A regulatory note: the FDA approved a generic injectable rifampin from a single manufacturer, which supports supply and competition rather than adding a new drug or indication. A clinic pearl: give Tdap in every pregnancy, ideally 27–36 weeks, regardless of prior vaccination, to protect the newborn before their own vaccines begin. Finally, ISLEND-1, a phase 3 trial of 607 adults with HIV-1 already suppressed on daily bictegravir-emtricitabine-tenofovir alafenamide, found a switch to once-weekly oral islatravir-lenacapavir was non-inferior: 93.4% versus 92.4% kept viral load under 50 copies/mL at 48 weeks, with stable CD4 counts. A weekly oral option could ease the adherence burden of daily therapy for suppressed patients, pending availability and cost.