Psilocybin in the Treatment of Cocaine Use Disorder – A Randomized Clinical Trial
In this randomized, quadruple-blind trial, 40 adults with cocaine use disorder received either a single dose of psilocybin or active placebo, combined with structured psychotherapy. Participants treated with psilocybin had significantly more cocaine-abstinent days, higher rates of complete abstinence, and a lower risk of relapse over 180 days compared with placebo. No serious adverse events were reported. Clinical implications: These findings suggest that psilocybin-assisted psychotherapy may represent a promising new treatment approach for cocaine use disorder, a condition for which no FDA-approved medications currently exist. Full Access: JAMA
Efficacy And Safety of Cefepime–Nacubactam and Aztreonam–Nacubactam Compared with Imipenem–Cilastatin for Complicated Urinary Tract Infection or Acute Uncomplicated Pyelonephritis (Integral-1): A Double-Blind, Randomized Phase 3 Trial
The Integral-1 trial was a global, double-blind, randomized phase 3 study that enrolled 614 adults with complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis across 79 sites. The primary composite endpoint of clinical cure plus microbiological eradication at test of cure was achieved by 82% of the cefepime–nacubactam group, 72% of the aztreonam–nacubactam group, and 61% of the imipenem–cilastatin group. Clinical implications: These results position cefepime–nacubactam as a promising carbapenem-sparing option for hospitalized patients with Gram-negative cUTI or pyelonephritis, including resistant strains — a critical need given rising ESBL prevalence — with the ongoing Integral-2 trial extending evaluation to carbapenem-resistant Enterobacterales. Full Access: The Lancet
Oral Antiviral Xocova Approved for COVID-19 Postexposure Prophylaxis
The FDA recently approved ensitrelvir (Xocova) as the first oral antiviral for post-exposure prophylaxis of COVID-19 in adults and adolescents aged 12 years and older following close contact with an infected individual. In the phase 3 SCORPIO-PEP trial, ensitrelvir reduced the risk of developing symptomatic COVID-19 by 67% compared with placebo when started within 72 hours of exposure and was generally well tolerated. Clinical implications: Ensitrelvir offers a new preventive option for patients with recent high-risk exposure, particularly those at increased risk for complications or in settings where transmission risk is high. Full Access : MPR
Point-of-Care Ultrasound for the Diagnosis of Pneumonia
POCUS is an accurate bedside tool for diagnosing pneumonia and often outperforms chest radiography, particularly for detecting peripheral lung consolidations. The review highlights its advantages of rapid assessment, lack of radiation exposure, portability, and usefulness in resource-limited settings. Characteristic findings include subpleural consolidations, dynamic air bronchograms, pleural line abnormalities, and focal B-lines. Evidence suggests lung ultrasound has high sensitivity and specificity and can approach CT-level diagnostic performance in selected patients. Clinical implications: POCUS can expedite diagnosis and treatment decisions in emergency, urgent care, and inpatient settings, while reducing reliance on chest X-rays and unnecessary radiation exposure. Full Access: JAMA