ECDC Issues Guidance on Doxycycline for STI Prevention
Clinical data show doxy-PEP can significantly lower chlamydia and syphilis incidence in high-risk groups when taken within 24–72 hours after condomless sex, but it is unlikely to reduce gonorrhea where tetracycline resistance is common. Due to concerns about accelerating antimicrobial resistance in STI pathogens and bystander bacteria, ECDC does not endorse population-wide use and advises clinicians to base use on individual risk and integrate it into comprehensive STI prevention strategies. Clinical implications: Clinicians should consider doxy-PEP on a case-by-case basis for patients at highest risk (e.g., MSM with prior STIs), counsel about limited effect on gonorrhea and potential for resistance, and ensure linkage with regular testing, vaccination, and safer-sex counseling. Full Access: ECDC
Intranasal Treatments for Children with Sleep-Disordered Breathing. The MIST+ Randomized Clinical Trial
The MIST+ randomized clinical trial evaluated whether 6 weeks of intranasal steroid was more effective than saline in treating persistent obstructive sleep-disordered breathing (OSDB) symptoms in children aged 3–12 years after an initial saline run-in. Both continued saline and intranasal steroid treatment led to symptom resolution in about one-third of children, with no significant difference between groups. Clinical implications: A course of intranasal saline alone may be an effective first-line therapy for pediatric OSDB before specialist referral or surgical evaluation, potentially reducing unnecessary use of steroids and lowering surgical waitlist burden. Full Access: JAMA
Oral Ivermectin Versus 5% Permethrin Cream to Treat Children and Adults with Classic Scabies: Multicenter, Assessor Blinded, Cluster Randomized Clinical Trial
The study found that oral ivermectin did not demonstrate non-inferiority to permethrin for achieving clinical cure by day 28, whereas 5% permethrin was statistically superior in cure rates at the cluster and individual levels. Adverse skin events were relatively similar between groups. The trial included patients from multiple French hospitals and was designed to assess both index cases and their household contacts. Clinical implications: These results support continuing to use topical 5% permethrin cream as the preferred first-line therapy for classic scabies, given its superior effectiveness in this trial. Oral ivermectin may still have a role in selected cases (e.g., permethrin intolerance or logistical challenges with topical therapy), but clinicians should be cautious about substituting ivermectin as routine first-line treatment without further evidence. Full Access: BMJ
Safety And Immunogenicity of Panchol, A Single-Dose Live-Attenuated Oral Cholera Vaccine: Results from A Phase 1a, Double-Blind, Randomized, Placebo-Controlled Trial
The article reports phase 1 clinical trial results for a new single-dose, live-attenuated oral cholera vaccine showing favorable safety and immunogenicity in healthy adult volunteers. The vaccine elicited strong immune responses against Vibrio cholerae with mostly mild, transient side effects and demonstrated genomic stability. These early results support further testing in cholera-endemic regions to assess efficacy and public health impact. Clinical implications: If subsequent trials confirm efficacy, PanChol could simplify cholera prevention programs with a single oral dose, improving uptake and protection in high-risk populations, especially in resource-limited settings with frequent outbreaks. Full Access: The Lancet