FOR OUTPATIENT DIVERTICULITIS, AMOXICILLIN–CLAVULANATE PREFERABLE TO METRONIDAZOLE PLUS FLUOROQUINOLONE?
In an observational study, researchers analyze the effectiveness and harms of metronidazole-with-fluoroquinolone versus amoxicillin–clavulanate for outpatient diverticulitis. There were no differences in 1-year admission risk, 1-year urgent surgery risk, 3-year elective surgery risk between groups. Authors conclude that treating diverticulitis in the outpatient setting with amoxicillin–clavulanate may reduce the risk for fluoroquinolone-related harms without adversely affecting diverticulitis-specific outcomes.
Full Access: Annals of Internal Medicine
ASSOCIATION BETWEEN THIRD-GENERATION FLUOROQUINOLONES AND ACHILLES TENDON RUPTURE: A SELF-CONTROLLED CASE SERIES ANALYSIS
Researchers used administrative claims data to identify 504 patients with Achilles tendon rupture who had received antibiotic prescriptions. Risk of rupture was not significantly elevated during exposure to third-generation fluoroquinolones (IRR = 1.05; 95% CI, 0.33-3.37) and nonfluoroquinolones. In contrast, risk was significantly elevated during exposure to first- and second-generation fluoroquinolones. Study has some limitations, including the use of an administrative claims database. Article suggests that third-generation fluoroquinolone use was not associated with an increased risk of Achilles tendon rupture. These antibiotics may be a safer option for patients in whom this risk is elevated, such as athletes.
Full Access: Annals of Family Medicine
ASSOCIATION BETWEEN VACCINATION WITH BNT162B2 AND INCIDENCE OF SYMPTOMATIC AND ASYMPTOMATIC SARS-COV-2 INFECTIONS AMONG HEALTH CARE WORKERS
In this retrospective cohort study conducted in Israel that included 6710 health care workers who underwent periodic testing for SARS-CoV-2 with potential exposure. Vaccination with the BNT162b2 vaccine was associated with an adjusted incidence rate ratio of 0.03 for symptomatic infection and 0.14 for asymptomatic infection more than 7 days after the second dose (both statistically significant). Symptomatic SARS-CoV-2 infection occurred in 8 fully vaccinated health care workers. Asymptomatic SARS-CoV-2 infection occurred in 19 fully vaccinated health care workers. Vaccination with 2 doses of the BNT162b2 messenger RNA vaccine was associated with significantly lower incidence rates for both symptomatic and asymptomatic SARS-CoV-2 infection.
Full Access: JAMA
COVID-19 VASCULITIS AND NOVEL VASCULITIS MIMICS
Patients with severe COVID-19 pneumonia can develop cutaneous vasculitis-like lesions and systemic arterial and venous thromboemboli, including cryptogenic strokes and other vasculopathy features. This article highlights how imaging and post-mortem findings from patients with COVID-19 indicate a novel thrombosis in the pulmonary venous territory distal to the alveolar capillary bed, which might represent an unappreciated nidus for systemic microembolism. Necrotic skin lesions were reported in 6% of patients with cutaneous pathology associated with COVID-19 and were associated with older age, increased disease severity, and a 10% higher risk of mortality.
Full Access: The Lancet