Shorter course of antibiotics found noninferior for orthopedic surgery patients

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Surgeon with white gloves making an incision in patient's wrist — nicoletaionescu / iStock

The results of a multicenter randomized controlled trial indicate that a short course of systemic antibiotics is noninferior to a long course in patients who’ve undergone orthopedic surgery, researchers reported last week in the New England Journal of Medicine.

Conducted at 25 sites in the United Kingdom, Austria, Germany, Portugal, and Spain, the SOLARIO (Short or Long Antibiotic Regimens in Orthopaedics) trial randomly assigned 500 patients who’d undergone surgery for a confirmed orthopedic infection to receive postoperative antibiotic therapy for a short duration (seven days or less) or a long duration (four or more weeks). Local antibiotics were delivered by a device that was implanted during surgery. The primary outcome was definite treatment failure by 12 months, with a noninferiority margin of 10 percentage points.

Postoperative systemic antibiotic treatment for orthopedic infection typically lasts at least four weeks.

“Orthopedic infection is usually managed with surgery and prolonged systemic antibiotic therapy,” a team led by investigators from Oxford University Hospitals wrote. “Whether local antibiotics delivered by a product implanted at the infection site during surgery can reduce the duration of systemic antibiotic therapy is unclear.”

Less treatment failure, fewer side effects

Definite treatment failure occurred in 14.1% of patients in the long-duration group and 11.1% in the short-duration group, for a risk difference of –3.0 percentage points, which met the prespecified noninferiority margin. Results of sensitivity analyses were consistent with the primary analysis.

Potential side effects of antibiotic therapy, a secondary outcome, occurred in 45.2% of patients in the long-therapy group and 17.2% of patients in the short-duration group (risk difference, –28.0 percentage points.)

“The anticipated advantages of short-duration therapy, which include fewer symptoms associated with treatment and shorter durations of hospital stay without an increased risk of death or serious adverse events, were seen in the current trial,” the authors wrote.

Trump pushes for more control over NIH research dollars

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Sarah Boden

The White House is seeking greater control over $48 billion in federal research funding, in an apparent effort to further President Donald Trump's political agenda, according to recent reporting from the Washington Post, New York Times, and Politico.

Russell Vought talks with journalists during a March 2019 press briefing, back when he was acting director of the Office of Management and Budget. Standing behind a podium, in front of an American flag, Vought points to his right as if to call on one of the reporters, many of whom have raised their hands. Vought wears a dark blue-gray suit and red tie. He is white, balding and has brown-framed glasses. — *White House Press Briefing / flickr*

The president has reportedly ordered Russell Vought, director of the Office of Management and Budget, to draft an executive order that would require grant applications to the National Institutes of Health (NIH) to be reviewed by a board of political appointees.

The Times reports that Trump's goal is to promote conservative ideology and cultural change through directing scientific research at the nation's more prestigious universities, which the president has frequently sparred with during his second term.

The effort has drawn rebuke from those concerned with academic freedom, including the advocacy organization Stand Up for Science, which warns that this rule threatens to undermine decades of peer-reviewed research.

"These actions show us an administration determined to take control of our science," Stand Up for Science CEO Colette Delawalla, PhD, said in a statement.

Vought keeps coming after NIH oversight

Shifting decision power over federal research funding has been an ongoing project of Vought's. In May, his office proposed a rule that would require "senior appointees," selected by politically appointed agency heads, to review NIH research proposals.

The proposed rule states that this change would enhance accountability, encourage agencies to broaden the range of recipients, and ensure that "discretionary awards advance the President's policy priorities." It also specifically states that federal funding can't go to research that endorses or advocates "for the notion that sex is a chosen or mutable characteristic."

Currently, NIH grant applications go through a two-step review process, which includes both non-federal scientists and the relevant national advisory council or board. Final approval rests with the director of a specific NIH institute or center, such as the National Cancer Institute or the National Institute of Allergy and Infectious Diseases.

Quick takes: Pennsylvania asks CDC to recognize measles deaths, Trump's push to split up vaccine doses

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Stephanie Soucheray, MA

-Pennsylvania Secretary of Health Debra L. Bogen, MD, sent a letter to the Centers for Disease Control and Prevention (CDC) formally requesting the agency recognize the state’s four measles deaths as a condition of receiving emergency assistance (Epi-Aid) from the agency. “The CDC’s choice not to publicly recognize the deaths undermines our response,” Bogen wrote. “For this reason, if CDC is unable to transparently and accurately communicate information about those measles-associated deaths, the Department will respectfully rescind our request for a CDC Epi-Aid.” Pennsylvania Gov. Josh Shapiro first mentioned this request late last week. According to the state’s dashboard, there are now 792 measles cases in Pennsylvania, with 93 new cases reported in the last week. Four people have died, and 150 have been hospitalized.
In the Oval Office on Friday, President Trump said he would propose breaking up some childhood vaccine doses into five separate shots, reducing the vaccine dose to 20% of a single shot. “We’re going to recommend that they do five doses marked one, two, three, four, five and that they be given in six-month intervals, so that a small amount of the vaccine gets pumped into the body,” Trump said. He did not specify which vaccines he was talking about but suggested the move would result in a “massive reduction in autism.” Vaccine experts were quick to say this plan would render vaccines ineffective. Earlier this year, Trump suggested doctors split the measles, mumps, and rubella vaccine into separate vaccines, another move experts said would result in more vaccine-preventable illnesses.