Empirical Antibiotic Prophylaxis Versus Culture-Directed Enhanced Prophylaxis for Prevention of Urinary Tract Infection After Flexible Ureteroscopy in Children: A Randomized Controlled Trial
In this single-center RCT, 140 children (ages 4–16) with kidney or ureteral stones who received preoperative ureteral stents were randomized to standard empirical antibiotic prophylaxis (IV ceftriaxone before and 24 hours after flexible ureteroscopy) versus culture-directed enhanced prophylaxis (urine culture 10 days preoperatively, with targeted antibiotics for 5 days before through 2 days after surgery if positive). Researchers found that culture-directed, targeted antibiotic therapy with optimal dosing produced a more substantial reduction in UTI and complication rates compared to empirical prophylaxis alone. Clinical implications: this reinforces that a tailored, culture-guided antibiotic approach — rather than reflexive broad-spectrum empirical dosing — may better prevent infectious complications, supporting judicious antibiotic stewardship even in periprocedural settings. Full Access: Journal of Pediatric Urology
Phase 3 Trial of Weekly Oral Islatravir–Lenacapavir for HIV-1 Treatment
This is the NEJM report of the ISLEND-1 phase 3 trial (a double-blind, active-controlled noninferiority trial) showed that more than 93% of participants maintained viral suppression with weekly regiment, and no one experienced virologic failure, meeting noninferiority with a safety profile comparable to standard daily therapy — though one unvaccinated participant developed hepatitis B and discontinued treatment, a known risk since the regimen lacks tenofovir’s anti-HBV activity. Clinical implications: Expect a growing population of stable HIV patients on a once-weekly oral regimen rather than daily pills. Full Access: NEJM
FDA Approves Furosemide Autoinjector for At-Home Treatment of Edema in CHF, CKD
The FDA has approved Furoscix Ready Flow (furosemide injection), a fixed-dose 80 mg/mL subcutaneous autoinjector for treating edema in adults with heart failure or chronic kidney disease for the treatment of edema in adults with heart failure (HF) or chronic kidney disease (CKD). The most common adverse effects were injection-site reactions such as erythema, bruising, edema, and pain, with an otherwise safety profile consistent with oral and IV furosemide. Clinical implications: This offers a fast, in-office or take-home option for volume overload in HF/CKD patients who don’t need full ED-level workup. It could also support bridging therapy — administering a dose in urgent care while arranging outpatient cardiology/nephrology follow-up — for patients who present with mild-to-moderate fluid overload but are otherwise stable. Full Access: MRP
Nicotine E-Cigarettes for Cigarette Smoking Cessation Recommendations to US-Based Clinicians
This new JAMA Special Communication reviews evidence that nicotine e-cigarettes outperform standard nicotine replacement therapy for smoking cessation, with Cochrane data showing higher-certainty quit rates versus NRT and cessation rates comparable to varenicline/ cytisine, while exposing users to far fewer combustion-related toxicants than cigarettes despite ongoing misperceptions of equal or greater harm. The workgroup’s core recommendation is to routinely include e-cigarettes alongside FDA-approved pharmacotherapies (NRT, varenicline, bupropion) in shared decision-making conversations, without requiring patients to fail first-line medication before trying an e-cigarette. Clinical implications: This means clinicians fielding smoking-cessation questions or writing quit-attempt discharge instructions can reasonably offer FDA-authorized e-cigarettes as an option. Full Access: JAMA