Trimethoprim-Sulfamethoxazole and Acute Respiratory Failure in Adolescents and Young Adults
In a cohort of healthy adolescents and young adults who started treatment with Trimethoprim‑Sulfamethoxazole (TMP–SMX), the 30-day risk of a hospital visit for respiratory failure was higher than among those who started with amoxicillin or cephalosporins. This elevated risk supports recent warnings from the FDA about potential severe pulmonary adverse events associated with TMP–SMX. Clinical implications: Clinicians should carefully consider antibiotic choice, weighing the benefits of TMP–SMX against this increased short-term risk of respiratory failure. Alternative antibiotics may be safer first-line agents in many cases. Additionally, patients started on TMP–SMX should be counseled about warning signs of respiratory distress and monitored more closely in the first month after prescription. Full Access: JAMA
New Flu Variant Could Bring Another Severe US Season
A newly emerged influenza A H3N2 subvariant called “subclade K”, first seen overseas and carrying multiple mutations, is raising alarm for a potentially severe flu season ahead in the U.S. Because this variant was not included in this year’s flu vaccine, experts warn the mismatch could reduce vaccine effectiveness — especially among the elderly and other high-risk groups — possibly leading to increased hospitalizations. Clinical Implications: Clinicians should expect a surge in flu-related illness, emphasize timely vaccination even if imperfect, maintain a high index of suspicion for influenza complications, and consider early antiviral therapy or prophylaxis in high-risk patients. Full Access: Pulmonology Advisor
Glucagon-Like Peptide-1 Receptor Agonists and Chronic Cough
In a large cohort study of over 427,000 patients on GLP-1 receptor agonists (GLP-1RAs) versus more than 1.6 million on other second-line diabetes medications, use of GLP-1RAs was associated with a significantly increased risk of developing new chronic cough. The increased risk persisted even after adjusting for gastroesophageal reflux disease (GERD). Clinical implications: this suggests that when prescribing GLP-1RAs — particularly for patients at risk for airway sensitivity or chronic respiratory symptoms — clinicians should monitor for cough and consider alternative therapies if cough develops. It also raises the need for further research into the mechanisms of GLP-1RA–related cough and whether dose adjustment or choice of drug class can mitigate this effect. Full Access: JAMA
Air Pollution Exposure and The Burden of Pediatric Upper Respiratory Tract Infections in Emergency Departments: A Retrospective Time-Series Study
The study examined 2,572 pediatric emergency department (ED) visits for upper respiratory tract infections (URTI) between 2015 and 2020 and assessed daily ambient air pollutant levels. The findings suggest that CO and SO₂ pollution are significant risk factors for pediatric URTIs and highlight the role of environmental air quality in respiratory morbidity among children. Clinical Implications: this reinforces the need for Urgent Care and ED physicians to consider environmental exposure in respiratory illness risk assessments, and supports public health efforts to reduce air pollution to prevent pediatric respiratory disease. Full Access: European Journal of Pediatrics