Prophylaxis beyond a day did not lower meningitis after endonasal skull-base surgery, across 7,981 patients

The edition in brief

A meta-analysis of 14 studies and 7,981 patients undergoing endoscopic endonasal skull-base surgery found postoperative meningitis in 1.38%. Rates were 1.24% with prophylaxis of one day or less, 1.20% with one to three days and 2.12% with more than three days, with no significant difference; intraoperative CSF leak, not antibiotic duration, tracked with meningitis. The evidence is observational and heterogeneous. A phase 2b/c proof-of-concept trial in South Africa, published in May, found four months of delamanid, bedaquiline and quabodepistat achieved culture conversion in 96% against 100% on six months of standard therapy in 122 adults with drug-susceptible TB, meeting a 12% non-inferiority margin; relapse data are not yet available. A first-in-human phase 1 trial of a ChAdOx2 Crimean-Congo haemorrhagic fever vaccine in 46 UK adults reported mostly mild reactogenicity, no serious adverse events and rising antibody after a second dose. In the AZTEC trial, ten days of intravenous azithromycin in 693 infants born before 30 weeks reduced gut diversity, enriched Staphylococcus and Enterobacter/Klebsiella and increased macrolide-resistance genes that persisted. The FDA recorded a supplement to a generic rifampin application, an administrative action.