The edition · Infectious Diseases
Five days of antibiotics for non-severe childhood pneumonia: similar failure rate, far better adherence
A ten-trial meta-analysis backs short courses, a new kelch13 mutation linked to slow parasite clearance spreads across Zambia, and a two-drug HIV switch holds suppression to 96 weeks.
The edition in brief
A meta-analysis of ten randomised trials (8,970 children) with non-severe community-acquired pneumonia found five days or fewer of antibiotics gave similar treatment failure (RR 1.07, 95% CI 0.93 to 1.24) and relapse (RR 1.04) to longer courses, while non-adherence fell by about two-thirds (RR 0.35). In Zambia, a previously undescribed Pfkelch13 mutation, A724E, was found in about half of falciparum isolates in two western provinces and rose from 0% to 79% in one district between 2018 and 2026. In that district, 28% of patients carrying it were still parasitaemic on day 3 after artemisinin-based combination therapy against none with the wild type, the clinical marker of partial resistance. In the phase 2 DORAL trial, 114 adults with long-suppressed HIV switched to once-daily doravirine plus raltegravir had one virological failure by week 48 and none more by week 96. The FDA lists an ongoing Class II recall of one premixed intravenous vancomycin product for manufacturing-practice deviations. The pearl: a day-3 blood smear after treatment for falciparum malaria is the simplest bedside check for slow clearance.
A new kelch13 mutation linked to slow artemisinin clearance is spreading in Zambia
In falciparum malaria acquired in western Zambia, check a day-3 smear and report persistent parasitaemia; partial resistance is now well established there.
Doravirine plus raltegravir: a two-drug switch with one failure in 114 patients
Treat doravirine plus raltegravir as a possible switch for selected suppressed patients with interaction problems, pending larger trials.
FDA lists a Class II recall of one premixed intravenous vancomycin product
Ask pharmacy to check imported premixed vancomycin stock against the FDA recall; vancomycin itself is unaffected.
Falciparum malaria: the day-3 smear is your resistance check
Repeat the blood smear on day 3 of treatment for falciparum malaria and act on persistent parasitaemia.
Five days or less for non-severe childhood pneumonia: similar failure rates, far fewer missed doses
Consider five days of antibiotics for non-severe community-acquired pneumonia in otherwise healthy children, with clear safety-net advice.
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