The Effectiveness of Nirsevimab on Antibiotic Use in Children Using Target Trial Emulation
This target trial study showed Nirsevimab was associated with a 14.4% reduction in antibiotic prescribing for outpatient acute respiratory tract infections. It also showed a 40.3% reduction in antibiotic prescribing for outpatient bronchiolitis. Most strikingly, there was a 69.4% reduction in antibiotic prescribing tied to RSV-related hospitalizations. Secondary analyses found comparable reductions for acute otitis media (27%) and other viral respiratory infections (23%). Clinical implications: Beyond preventing RSV disease itself, nirsevimab meaningfully reduces downstream antibiotic exposure in infants — reinforcing its role as an antibiotic stewardship tool, not just an RSV prophylactic. Full Access: IDSA
Southward Expansion of Ixodes scapularis (Blacklegged) Tick Pathogens — Western North Carolina, November 2024–August 2025
Community-based tick surveillance in western North Carolina collected 373 ticks, 76.9% of which were blacklegged ticks (Ixodes scapularis). Nearly 40% of tested adult Ix. scapularis carried Borrelia burgdorferi, the Lyme disease agent, with prevalence comparable to endemic Northeast/Midwest regions. Borrelia miyamotoi and the human-active strain of Anaplasma phagocytophilum were also detected, marking possibly the southernmost identification of these pathogens to date. Clinical implications: Urgent care clinicians in western NC/southern should raise suspicion for Lyme disease, anaplasmosis, and B. miyamotoi infection in patients with compatible symptoms and outdoor exposure, even without prior classification as an endemic area. Full Access: CDC
Effectiveness of Scabies Treatments in Italy (SCAB-Net): A Prospective Observational Study
SCAB-net was a prospective, multicenter observational study across 28 Italian dermatology centers (June 2024–Dec 2025), benzyl benzoate achieved an 84.2% cure rate and oral ivermectin 81.6%, while permethrin 5% cream lagged significantly at just 42.5%. Combination therapy offered no significant benefit over benzyl benzoate alone. Environmental decontamination counseling lowered failure risk, while immunosuppression and foreign nationality raised it. Clinical implications: Given permethrin’s markedly lower real-world cure rate, urgent care clinicians should consider oral ivermectin or benzyl benzoate as first-line options and consistently counsel on environmental decontamination to improve outcomes. Full Access: The Lancet
Early Testing May Identify Measles Before Rash Appears
A retrospective analysis of 120 measles rRT-PCR tests from a 2024 Chicago outbreak found the test can detect the virus up to 4 days before rash onset, though prodromal symptoms can resemble other viral syndromes. Researchers noted test sensitivity within 0–3 days of rash onset is well established. Findings suggest sensitivity may be lower when testing occurs more than 4 days before rash onset. Study limitations included inconsistent symptom reporting and a limited number of positive tests. Clinical implications: Consider rRT-PCR testing in suspected measles even before rash appears, especially during known outbreaks, but retest negative cases as symptoms evolve or rash develops given reduced early sensitivity. Full Access: Helio