A multicenter randomized clinical trial analyzed the effects of moxifloxacin vs ertapenem in 583 adults with uncomplicated acute appendicitis. Patients were treated with either 7 days of oral moxifloxacin or 2 days intravenous ertapenem followed by 5 days of levofloxacin and metronidazole. Treatment success (discharge from hospital without need for surgery and no recurrent appendicitis within 1 year) occurred in 70.2% who received oral antibiotics alone vs 73.8% of patients who received intravenous followed by oral antibiotics. Patients with acute, uncomplicated appendicitis treated with oral antibiotics alone met the prespecified threshold for treatment success but failed to demonstrate noninferiority relative to systemic antibiotics followed by oral antibiotics.
Full Access: JAMA

REDUCING EXPECTATIONS FOR ANTIBIOTICS IN PATIENTS WITH UPPER RESPIRATORY TRACT INFECTIONS: A PRIMARY CARE RANDOMIZED CONTROLLED TRIAL
Overuse of antibiotics drives the emergence and spread of antimicrobial-resistant organisms, which pose a major threat to public health. A 3-arm randomized controlled trial among patients presenting with Upper Respiratory Tract Infections (URTIs) in New Zealand, compared the effects of viewing 2 brief tablet-based educational presentations, designed to reduce expectations for antibiotics in patients with URTIs. Participants who viewed either the futility or the adverse effects presentation had greater reductions in their expectations to receive antibiotics than the control group. Researchers found that results are in agreement with those of other studies that highlight the impact of patients’ beliefs and expectations on inappropriate antibiotic prescribing.
Full Access: Annals of Family Medicine

HOW TO HELP RUNNERS STEER CLEAR OF INJURY
The Journal of Family Practice published an article for healthcare workers to counsel runners and prevent injuries. More than 60% of runners report overuse injuries annually and these are commonly seeing in Urgent Care settings. Clinicians must accurately diagnose and manage such injuries and counsel patients about how to prevent them. The article includes suggestions like cross-training, replace shoes regularly, use shoes with moderate-to-high (8-12 mm) heel-to-toe drop, don’t discourage running for exercise (as long as it is tolerated) in patients who have osteoarthritis, encourage moderation in running distance and intensity, especially in novice runners, among other recommendations.
Full Access: MDedge

BNT162B2-ELICITED NEUTRALIZATION AGAINST NEW SARS-COV-2 SPIKE VARIANTS
On May 12^th, 2021, JAMA reported that recombinant SARS-CoV-2 bearing S genes from the B.1.1.7 variant (South Africa), and the variant first identified in Brazil remained susceptible to BNT162b2 vaccine–elicited serum neutralization, although at a reduced level for the B.1.351 variant.  An inherent limitation of the study is that new SARS-CoV-2 variants continuously emerge, so the set of strains of current concern constantly shifts. Nevertheless, some mutations are of particular interest, because these data show that the newly emerged B.1.526, B.1.429, and B.1.1.7+E484K variants remain susceptible to an important vaccine-elicited immune effector (neutralizing antibody).  Researchers confirm the importance of mass immunization with current, highly effective, authorized vaccines as a central strategy to end the Covid-19 pandemic.
Full Access:  JAMA