The edition · Infectious Diseases
Azithromycin at unplanned caesarean spread after the trial, and postpartum infections fell
US records from 1.66 million births show adjunctive azithromycin use at unscheduled caesarean rose from 2% to 40% after 2016, with a 2-point fall in postpartum infection. Also: no excess severe infection with SGLT2 inhibitors, and a small trial of rifamycin and the cirrhotic resistome.
The edition in brief
Today's infectious diseases edition closes on a US difference-in-differences analysis of 1,663,441 births from 2013 to 2024. After the 2016 trial showing benefit, adjunctive azithromycin at unscheduled caesarean rose from 2.2% to 39.6% of such births, and postpartum infection fell relative to vaginal births by an adjusted 2.0 percentage points (95% CI 1.4 to 2.6). A meta-analysis of real-world cohorts found no increase in severe infection with SGLT2 inhibitors against DPP-4 inhibitors; the pooled ratio for pneumonia was 0.65, but certainty was very low and the authors warn against reading it as protection. A 30-patient randomised trial in compensated cirrhosis found 30 days of rifamycin SV MMX did not enrich gut antimicrobial resistance genes compared with placebo. The FDA lists a supplement to an approved generic daptomycin application, an administrative action. The pearl covers why daptomycin should not be used for pneumonia, and the creatine kinase checks it needs.
SGLT2 inhibitors and severe infection: no excess against DPP-4 inhibitors in real-world cohorts
Real-world data do not show SGLT2 inhibitors raising pneumonia or sepsis risk compared with DPP-4 inhibitors, so infection fear need not hold back a prescription.
Rifamycin SV MMX for 30 days did not enrich resistance genes in compensated cirrhosis
A 30-patient pilot found no resistance-gene expansion with a gut-targeted rifamycin in cirrhosis; it neither confirms nor dismisses the concern for rifaximin.
FDA records a supplement to a generic daptomycin application
This is an administrative supplement to a generic daptomycin licence; it needs no change in practice.
Daptomycin does not treat pneumonia, and it needs creatine kinase checks
Choose a different anti-MRSA agent for pneumonia, and monitor creatine kinase weekly on daptomycin.
Adjunctive azithromycin at unscheduled caesarean: wider use, fewer postpartum infections
For caesarean after labour or ruptured membranes, consider adding single-dose azithromycin to standard prophylaxis and put it in the order set.
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