Impact of a Multi-Center Collaborative on Antibiotic Duration for Acute Respiratory Infections in Pediatric Urgent Care
This secondary analysis covered 257,879 antibiotic encounters at 92 pediatric urgent care sites in 22 states and Washington, DC. The collaborative targeted equitable first-line antibiotic selection, not duration. Even so, the odds of a course of 7 days or less rose 22% during the intervention and 31% afterward. The authors credit this spillover to culture change and guideline awareness, alongside secular trends.
Urgent Care implications: Stewardship work on drug choice also shortens courses, so build short durations into order sets. Default to 7 days or less for uncomplicated respiratory infections where guidelines allow.
Full access: Journal of the Pediatric Infectious Diseases Society
Clinical Practice Guidelines on Antiviral Therapies for Adults With COVID-19 Infection
This letter flags two prescribing-safety errors in JAMA’s recent synopsis on antivirals for mild-to-moderate COVID-19. For molnupiravir, the FDA and IDSA call for contraception during treatment plus 4 days for females and at least 3 months for males. The synopsis wrongly gave females 3 months, omitted male counseling, and dropped the 4-day breastfeeding hold. For Paxlovid, it mislabeled tamsulosin, triazolam, and midazolam as PDE5 inhibitors. Per the label, amiodarone, simvastatin, lovastatin, triazolam, and oral midazolam are contraindicated; tamsulosin should be avoided; and sildenafil is contraindicated only for PAH, with dose adjustment for ED. Neither correction changes the guideline recommendations.
Urgent Care implications: Counsel molnupiravir patients by sex: women need 4 days of contraception, men need 3 months, and breastfeeding should be held for 4 days. Before prescribing Paxlovid, classify each interacting drug as contraindicated, avoid, or adjust/hold.
Full access: JAMA
Subacute Sclerosing Panencephalitis After Measles Outbreaks, the Philippines, 2007–2022
Subacute sclerosing panencephalitis (SSPE) is a delayed, almost uniformly fatal complication of measles. This review covered 20 children admitted with SSPE to a tertiary pediatric hospital in Manila. Median age was 6.2 years at admission and 0.7 years at the reported measles infection. A quarter of the admissions occurred in 2022, and four cases traced back to the 2018–2019 outbreak, so more cases may emerge in the coming years. A quarter of patients had no known measles history.
Urgent Care implications: Infant measles can cause fatal SSPE years later, which makes on-time 2-dose MMR vaccination critical. With US measles cases rising, consider SSPE in a child with new behavioral or cognitive decline and myoclonus, even without a known measles history.
Full access: CDC Emerging Infectious Diseases
Therapy for Adults With Complicated Urinary Tract Infection
This synopsis summarizes the 2025 IDSA guideline, which defines complicated UTI (cUTI) as infection beyond the bladder (fever, flank pain, bacteremia, or a catheter). Male sex and diabetes alone no longer make a UTI complicated. Empiric therapy follows four steps: assess for sepsis, review cultures from the past 3–6 months, check allergies and interactions, and use the local antibiogram if the patient is septic.
Urgent Care implications: Afebrile men with cystitis can now receive short courses. For stable cUTI, review prior cultures and avoid a fluoroquinolone if one was used in the past 12 months. Treat with TMP-SMX or a fluoroquinolone for 7 days.
Full access: JAMA
COVID-19 Vaccine Effectiveness and Safety for the 2026–2027 Respiratory Season
This systematic review included 155 studies of US-licensed COVID-19 vaccines. Updated vaccines were 53% effective against hospitalization in adults 65 and older and 54% in adults 18–64. Effectiveness against ED or urgent care visits was 58% in pregnancy and 76% in children aged 9 months to 4 years. No new safety signals were found.
Urgent Care implications: Use these data to counsel hesitant patients, especially older adults, pregnant patients and young children.
Full access: JAMA