The edition · Infectious Diseases
Fluoroquinolone regimens for brucellosis failed twice as often as doxycycline combinations
A meta-analysis argues against quinolones as first-line brucellosis treatment, cancer is tied to roughly double the odds of dying from sepsis, and household smoke is tied to childhood TB.
The edition in brief
A meta-analysis of nine randomised trials with 602 patients (PLOS Neglected Tropical Diseases, 23 October) found fluoroquinolone-based regimens for brucellosis carried about twice the risk of treatment failure of standard doxycycline-based combinations (RR 2.11, 95% CI 1.26 to 3.51) and took about a day longer to clear fever; relapse and adverse events did not differ significantly. A meta-analysis of 85 studies (Annals of Medicine, 30 October) found malignancy was associated with higher mortality in sepsis across most time points, with odds ratios of about 1.8 to 2.4, strongest and most sustained in haematological cancer; the estimates are unadjusted. A meta-analysis of 12 observational studies (IJTLD, 30 October) linked household second-hand smoke to about 2.7 times the odds of TB infection or disease in children in low-resource settings. The FDA lists a supplement to the linezolid new drug application dated 21 October; the record does not state its content. The pearl covers linezolid monitoring.
Cancer was associated with roughly double the odds of death in sepsis
Cancer is linked to roughly double the odds of dying from sepsis, especially haematological cancer, but should not on its own decide ICU care.
Household smoke was linked to higher odds of TB in children
Ask about household smoking when assessing a child for TB, and treat combined exposure as higher risk.
FDA lists a supplement to the linezolid new drug application
Note the linezolid label supplement, but check its content on the FDA site before changing practice.
Linezolid: count the weeks and check the drug list
Monitor blood counts weekly on long linezolid courses and check for serotonergic co-medication.
Keep doxycycline-based combinations first-line for brucellosis
Treat adult brucellosis with a doxycycline-based combination; fluoroquinolone regimens failed more often.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for infectious diseases, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free