Multicenter Evaluation Reveals Persistent Gaps in Guideline-Concordant Care

[Posted 8/Jul/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: This multicenter evaluation demonstrates that antibiotic prescribing for acute sinusitis remains substantially higher than recommended by evidence-based guidelines, with nearly one-third of patients failing to meet prescribing criteria and fewer than half of prescriptions fully adhering to recommended antibiotic selection and duration. Prolonged symptom duration, cough, and incomplete documentation were significant drivers of inappropriate prescribing, while electronic encounters were associated with more judicious antibiotic use. These findings identify important opportunities for antimicrobial stewardship interventions aimed at improving prescribing decisions and optimizing treatment duration in ambulatory care.

BACKGROUND: Acute sinusitis is among the most common indications for antibiotic prescribing in ambulatory practice, despite national guidelines recommending antibiotic therapy only when specific clinical criteria suggest bacterial infection. Inappropriate antibiotic use contributes to adverse drug events, antimicrobial resistance, and unnecessary healthcare expenditures. This multicenter study evaluated the appropriateness of antibiotic prescribing for acute sinusitis, assessed concordance with guideline-recommended agent selection and treatment duration, and identified factors associated with inappropriate prescribing.

DETAILS: This retrospective multicenter cohort study included 1,000 randomly selected adult ambulatory encounters with a primary diagnosis of acute sinusitis between January 1, 2024, and March 31, 2024. Encounters were drawn from emergency departments, urgent care centers, and primary care clinics across seven geographic regions within a large healthcare system. Medical records were reviewed to determine whether patients met national guideline criteria for antibiotic therapy based on symptom duration, severe symptoms, treatment failure, or double worsening. Antibiotic selection and treatment duration were evaluated against institutional recommendations. Multivariable logistic regression was performed to identify predictors of inappropriate antibiotic prescribing, and 30-day repeat respiratory-related healthcare utilization was also assessed. Among the 1,000 encounters, 676 (67.6%) met guideline criteria for antibiotic therapy, whereas 324 (32.4%) did not. Antibiotics were prescribed in 892 (89.2%) encounters overall. Prescribing occurred in 93.5% of encounters meeting treatment criteria but also in 80.2% of encounters where criteria were not satisfied, indicating substantial antibiotic use beyond guideline recommendations. Overall, only 49.2% of antibiotic prescriptions were fully guideline concordant with respect to both agent selection and duration. Guideline-concordant drug selection occurred in 74.1% of prescriptions, while 64.5% met recommended treatment duration. The most frequently prescribed antibiotic was amoxicillin/clavulanate (60.9%), followed by doxycycline (19.1%), and the median treatment duration was 7 days. However, 35.4% of patients received therapy lasting longer than 7 days. Watch-and-wait prescribing was used in only 6.8% of antibiotic-treated encounters. Multivariable analysis demonstrated that the presence of cough (OR 2.15; 95% CI, 1.08-4.29; P = 0.03), symptom duration of 7-9 days compared with 6 days (OR 7.70; 95% CI, 3.24-18.31; P 0.001), and undocumented symptom duration (OR 5.01; 95% CI, 1.41-17.82; P = 0.013) were independently associated with inappropriate antibiotic prescribing. In contrast, electronic encounters were associated with significantly lower odds of inappropriate prescribing than in-person visits (OR 0.03; 95% CI, 0.01-0.09; P 0.001). Unplanned respiratory-related healthcare contact within 30 days occurred in 12.8% of patients and was more frequent among those who did not receive antibiotics (20.4% vs 11.9%; P = 0.013), although antibiotic prescribing was not independently associated with reduced repeat healthcare utilization after multivariable adjustment.

Source: Arensman Hannan, K., Ilges, D., Le, K. T., Cole K, et al. Ambulatory antibiotic prescribing for acute sinusitis: a multicenter, retrospective cohort study evaluating appropriateness. Antimicrobial Stewardship & Healthcare Epidemiology.. 2026; 6(1): e193. Published: June 25, 2026. DOI: 10.1017/ash.2026.10743.

[Posted 13/Jul/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: This review underscores the expanding pipeline of therapeutic strategies targeting Candida auris, ranging from repurposed medications and next-generation antifungal agents to vaccines, antimicrobial peptides, nanoparticle formulations, and innovative environmental control measures. Although no single therapy has emerged as a definitive solution, compounds such as ibrexafungerp (SCY-078), ATI-2307, and fosmanogepix, together with drug repurposing and bioinspired approaches, represent promising avenues for addressing multidrug-resistant C. auris infections. Continued translational research and clinical evaluation remain essential to establish safe and effective treatment options for this increasingly important fungal pathogen.

BACKGROUND: Candida auris has rapidly emerged as a multidrug-resistant fungal pathogen of global concern since its first identification in 2009. The organism is associated with healthcare-associated outbreaks, high transmissibility, frequent misidentification, and severe invasive infections, with reported mortality rates ranging from 35% to 72%. Resistance to currently available antifungal agents further complicates treatment, with approximately 90% of isolates resistant to fluconazole, around 30% resistant to amphotericin B, and fewer than 5% resistant to echinocandins. These challenges have accelerated efforts to identify novel antifungal therapies and alternative treatment strategies.

DETAILS: This publication is a comprehensive narrative review that summarizes advances in antifungal research targeting C. auris over the preceding decade. The authors evaluated emerging therapeutic approaches from a medicinal chemistry perspective, including drug repurposing, combination therapy, novel antifungal agents, natural products, metal-based compounds, nanoparticles, vaccines, antimicrobial peptides, and environmental decontamination strategies. The review also examined chemical and physicochemical characteristics of promising compounds, including lipophilicity and topological polar surface area, to identify structural features that may facilitate future antifungal drug development. The review highlights several promising therapeutic candidates with activity against multidrug-resistant C. auris. Drug repurposing identified multiple agents with antifungal or antibiofilm activity, including sertraline, miltefosine, iodoquinol, octenidine dihydrochloride, taurolidine, and bensulfuron methyl. Miltefosine demonstrated fungicidal and antibiofilm activity, while encapsulation within alginate nanoparticles reduced toxicity and improved survival in an infected Galleria mellonella model. The NDV-3A vaccine generated cross-reactive antibodies against C. auris and protected neutropenic mice, with additive efficacy when combined with micafungin.

Among novel antifungal agents, SCY-078 (ibrexafungerp), an orally available 1,3-ß-D-glucan synthesis inhibitor, demonstrated potent activity against C. auris, with an MIC90 of 1 mg/L and MIC50 and MIC90 values of 0.5 µg/mL and 1 µg/mL, respectively, across 100 isolates representing the four major clades. More than 150 strains with diverse resistance profiles were subsequently shown to be uniformly susceptible to SCY-078, and the agent remained active against pan-resistant isolates while also exhibiting antibiofilm activity.

Additional investigational therapies also demonstrated encouraging preclinical activity. The arylamidine T-2307 (ATI-2307) exhibited in vitro MIC values ranging from 0.125 to 4 µg/mL and improved survival while reducing kidney fungal burden in murine infection models following 3 mg/kg once-daily subcutaneous treatment. Other experimental approaches included antimicrobial peptides, ceragenins, fluorinated hydrazone derivatives, and novel chemical scaffolds designed to overcome existing resistance mechanisms.

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Source: Billamboz, M., Fatima, Z., Hameed, S., et al. Promising Drug Candidates and New Strategies for Fighting against the Emerging Superbug Candida auris. Microorganisms. 2021; 9(3): 634. Published: March 18, 2021. DOI: 10.3390/microorganisms9030634.

[Posted 15/Jun/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: Study results suggest that clinicians should initiate antiviral chemoprophylaxis for at least 70% of eligible NH residents within 2 days of outbreak detection to lower risk of hospitalization.

BACKGROUND: Influenza outbreaks in nursing homes (NHs) pose a substantial threat to older adults, often resulting in morbidity and mortality. The Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) recommend prompt postexposure prophylaxis, also termed chemoprophylaxis or prophylaxis with oseltamivir, for all residents who are not ill to limit influenza spread in NHs. Purpose of the study is to examine whether initiating antiviral chemoprophylaxis for 70% or more of eligible NH residents within 2 days of influenza outbreak detection is associated with lower all-cause mortality and hospitalization at 14 and 30 days.

DETAILS: Retrospective cohort study using a sequential cluster-randomized target trial emulation and randomize-censor-weight approach for influenza outbreaks (September 1, 2018-May 31, 2022) in 12 US NH corporations. Eligibility criteria were age 18 years or older, present on the outbreak-detection day, no antiviral use in the preceding 7 days, no influenza in the past 14 days, and complete baseline data. Residents were followed up until hospitalization or death, an NH discharge to a nonacute-care location, or the end of follow-up. Data were analyzed from February 2023 to January 2026.

Exposures: Intensive antiviral chemoprophylaxis with oseltamivir (>=70% of eligible residents within 2 days of outbreak detection) or nonintensive antiviral chemoprophylaxis (0% to <70% of eligible residents).

Outcomes were all-cause death and hospitalizations within 14 and 30 days of outbreak detection. Discrete-time hazard models with pooled logistic regression were applied to estimate weighted risks, risk differences (RDs), and risk ratios (RRs).

Among 404 outbreaks in 318 NHs, 35,086 resident-trial observations (29,683 residents; median age 78 [IQR, 68- 86] years; 60% women; 81% White; 76% vaccinated) met eligibility criteria. Intensive oseltamivir prophylaxis was randomized to 17,155 observations; 17,931 were randomized to nonintensive care. At 14 days, intensive prophylaxis vs nonintensive yielded an RD of -0.06% (95% CI, -0.73% to 0.93%) and an RR of 0.96 (95% CI, 0.56-1.57) for death, and an RD of -0.96% (95% CI, -1.78% to -0.19%) and an RR of 0.79 (95% CI, 0.64-0.96) for hospitalization. At 30 days, the hospitalization differences persisted but were less precise and there continued to be no difference in death.

Copyright © American Medical Association. All Rights Reserved.

Source: Silva, J. B. B., Hsieh, H. T., Howe, C. J., et al. Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks. JAMA Internal Medicine.. 2026; 186(6): 714-722. Published: June, 2026. DOI: 10.1001/jamainternmed.2026.0401

A Randomized Controlled Comparative Study

[Posted 19/May/2026]

AUDIENCE: General Surgery, Family Medicine

KEY FINDINGS: Early active treatment with isotretinoin and FMRF is safe and better than isotretinoin monotherapy over 44 weeks regarding severity, reduced erythema, and improved surface roughness in moderate-to-severe acne vulgaris. This encourages early and effective treatment of acne to mitigate acne scarring and improve patients' quality of life.

BACKGROUND: Oral isotretinoin is the standard therapy for severe acne. However, scarring may persist. Fractional microneedling radiofrequency (FMRF) improves both inflammatory lesions and scars with minimal downtime. In this study, we compare isotretinoin monotherapy and concurrent isotretinoin and FMRF for active acne regarding clinical outcomes. The GAGS scores of isotretinoin and FMRF were significantly lower than those of isotretinoin monotherapy from weeks 12-44 (-79.69% vs. -60.34% at week 44, respectively; p < 0.001). Isotretinoin and FMRF showed significantly greater lesion count reductions than isotretinoin monotherapy at follow-up visits from weeks 12-44. Isotretinoin and FMRF showed significantly lower hemoglobin levels than isotretinoin monotherapy at weeks 32 and 44 (p = 0.029 and p < 0.001, respectively). Skin surface roughness improved substantially and persistently from week 12-44.

DETAILS: In this parallel two-group comparative study, patients received either low-dose isotretinoin monotherapy for 20 weeks (n = 34) or low-dose isotretinoin concurrently with 5 monthly FMRF sessions (n = 36). Outcomes were assessed at baseline and weeks 12, 20, 24, 32, and 44. The primary endpoints were Global Acne Grading System (GAGS) scores and inflammatory/non-inflammatory lesion counts. Secondary endpoints were hemoglobin indices and skin roughness.

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Source: Disphanurat, W., Leeyangyuen, P,, and Srisantithum, B. Efficacy of Low-Dose Oral Isotretinoin Combined With Fractional Microneedle Radiofrequency Versus Low-Dose Oral Isotretinoin Monotherapy in the Treatment of Moderate-To-Severe Acne Vulgaris: A Randomized Controlled Comparative Study. Lasers in Surgery and Medicine. 2026; 58(4): 321-330. Published: April, 2026. DOI: 10.1002/lsm.70120.

A Case Report

[Posted 2/Mar/2026]

AUDIENCE: General Surgery, Infectious Disease

KEY FINDINGS: PDT mediated by MB is an effective and affordable approach for treating FEH associated with HPV in immunosuppressed patients, offering favorable outcomes and improved quality of life.

BACKGROUND: Human papillomavirus (HPV) infections are a major cause of oral lesions, and in individuals living with HIV, lesions such as focal epithelial hyperplasia (FEH) may persist or exhibit atypical features, potentially progressing to more severe conditions if untreated. Managing oral HPV lesions in immunocompromised patients is challenging, as conventional therapies may carry higher risks or show limited efficacy.

DETAILS: This study reports the case of a 49-year-old HIV-positive male with valve disease and arthritis, requiring crutches for mobility. He presented with multiple painless oral lesions, diagnosed as FEH associated with oral HPV, and had previously undergone unsuccessful treatments. Photodynamic therapy (PDT) using methylene blue (MB) and a red laser was proposed as a treatment. Topical MB-mediated PDT successfully cleared the FEH lesions, with no recurrence observed over 24 months.

Copyright © Wiley Periodicals LLC. All rights reserved

Source: de Araújo, J. C., Paiva, H. C., Faara, P. M. M., et al. Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy. A Case Report. Lasers in Surgery and Medicine. 2026; 58(2): 70-73. Published: February, 2026. DOI: 10.1002/lsm.70091

[Posted 15/Dec/2025]

AUDIENCE: Gastroenterology, Infectious Disease

KEY FINDINGS:

• Vote Margin: The ACIP voted 8-3 to end the universal HepB birth dose recommendation.
• New Guidance: Vaccination at birth is recommended only for infants of mothers who are positive for HepB or have unknown status.
• Negative Mothers: Mothers who test negative are advised to consult their healthcare provider to decide the timing of their child's vaccination.
• Policy Impact: A change in the recommendation, if approved by the CDC Director, could affect state policies and private insurance coverage of the vaccine.

BACKGROUND: The Hepatitis B (HepB) vaccine has historically been universally recommended for all infants at birth by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP). This policy ensures protection against perinatal transmission and helps reduce the overall disease burden.

DETAILS: The CDC's Advisory Committee on Immunization Practices (ACIP) recently held a vote to reconsider the universal recommendation for the HepB vaccine at birth. The panel voted by a margin of 8-3 to cease the blanket recommendation that all infants receive the vaccine at birth. The new guidance maintains the recommendation only for infants whose mothers test positive for the infection or have unknown status. Mothers who test negative for Hepatitis B would be advised to "talk with their healthcare provider and decide themselves when to vaccinate their child." The discussion involved controversy, including a newly appointed ACIP member without medical training who reportedly argued against the universal birth dose, claiming vaccines had "never tested (the vaccines) appropriately." Dr. Cody Meissner, the sole continuing ACIP member, criticized the proposed change, stating "no rational science [had] been presented" to justify it. The ACIP voted in favor of changing the recommendations. These recommendations must now go to the CDC director for approval. While states ultimately set their own immunization policies, they generally rely on CDC guidelines. A change in ACIP recommendations can also influence insurance coverage, as most private insurers are required to cover recommended vaccines.

Reference: MacKenzie, M. ACIP Votes to End Hepatitis B Vaccine Recommendation for All Newborns. Healthcare Purchasing News. 2025; Published: December 6, 2025.