Editors of CMI Comms, Josh Davis, Erin McCreary and Emily McDonald return for round 2 taking turns to summarise and discuss late-breaker trials presented at ESCMID Global 2025 in Vienna, and whether or not these trials should change your practice. Part 2 covers the ALABAMA trial exploring the safety of penicillin-allergy delabelling using the penicillin allergy assessment pathway, the SOLARIO trial investigating short (≤7 days!) versus long (≥4 weeks) antibiotic courses for orthopaedic infections, the EAGLE-1 trial assessing oral gepotidacin for gonorrhoea, a randomised clinical trial (RCT) from Thailand on oral fosfomycin as carbapenem-sparing, de-escalating therapy in complicated UTIs, and a double-blind RCT from Israel comparing neutralising plasma to placebo for West Nile fever.   
 
This episode was peer reviewed by Dr. Emanuele Rando of Hospital Universitario Virgen Macarena, Seville, Spain and is the second of this two-part series covering selected clinical trials presented at ESCMID Global 2025. 
 
Late-breaker trials

• Sandoe J, et al. Penicillin allergy assessment pathway versus usual clinical care for primary care patients with a penicillin allergy record to assess safety, de-labelling and antibiotic prescribing: The ALABAMA randomised controlled trial
• Angkanavisan K, et al. Oral fosfomycin after carbapenems as de-escalating therapy in complicated urinary tract infection: A randomised
  controlled trial
• Canetti M, et al. Neutralising plasma versus placebo for hospitalised patients with West Nile fever: a double-blind randomised controlled trial
• Dudareva M, et al. Short or long antibiotic regimes in orthopaedics: the SOLARIO multicentre randomised controlled trial
• Wilson, J. Phase 3 randomised trial of oral gepotidacin for the treatment of uncomplicated gonorrhoea (EAGLE-1) 

References

• IDSA. Public Comment: IDSA Guideline on Management and Treatment of Complicated Urinary Tract Infections; 19 Feb - 19 March 2025.
• Mostashari F, et al. Epidemic West Nile encephalitis, New York, 1999. Lancet. 2001. doi: 10.1016/S0140-6736(01)05480-0
• Angus DC. Optimizing the Trade-off Between Learning and Doing in a Pandemic. JAMA. 2020. doi: 10.1001/jama.2020.4984
• Dudareva M. In: The 42nd Annual Meeting of the European Bone & Joint Infection Society. Barcelona, Spain: 26-28 Sept 2024. 
• Li HK, et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA). NEJM. 2019 doi: 10.1056/NEJMoa1710926

This episode of Communicable takes on a special format where editors of CMI Comms, Marc Bonten, Josh Davis, Erin McCreary, Emily McDonald, all clinical trialists in their own right, take turns to summarise and discuss late-breaker trials presented at ESCMID Global 2025 in Vienna. These include the CloCeBa trial on Staphylococcus aureus bacteraemia treatment options, the Taper V trial on vancomycin as prophylaxis for Clostridioides difficile infection, the ASTARTÉ trial on temocillin versus meropenem for bacteraemia due to third-generation cephalosporin-resistant Enterobacterales, the HARVEST trial investigating high doses of rifampicin for tuberculosis meningitis, and the CAP5 trial on shortening antibiotic treatment for community-acquired pneumonia. 
 
This episode was peer reviewed by Dr. Barbora Píšová (Czech Republic) and is the first of a two-part series covering selected clinical trials presented at ESCMID Global 2025. 

References: 

• Lescure X, et al. Cloxacillin versus cefazolin for methicillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa): a randomised, controlled, non-inferiority trial
• McDonald EG, et al. Initial vancomycin taper for the prevention of recurrent Clostridioides difficile infection: the TAPER-V randomised controlled trial
• Cogliati Dezza F, et al. Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistant Enterobacterales (ASTARTÉ): a randomised, pragmatic trial
• Van Crevel R, et al. High-dose rifampicin in the treatment of tuberculous meningitis: results of the HARVEST phase III multi-country randomised clinical trial
• Bastrup Israelsen S, et al. Shortened antibiotic treatment for 5 days in patients hospitalised with community-acquired pneumonia (CAP5): a multicentre randomised controlled noninferiority trial

In this first-ever collaboration between Communicable and Breakpoints, the podcast of the US Society of Infectious Diseases Pharmacists, hosts Angela Huttner (Geneva, Switzerland) and Erin McCreary (Pittsburgh, USA) join trial investigators Josh Davis (Newcastle, Australia) and Steve Tong (Melbourne, Australia) to unpack the first results coming from the SNAP adaptive platform trial, which were recently presented at ESCMID Global in Vienna. Learn whether penicillin and cefazolin are non-inferior to—and maybe even safer than—flucloxacillin for penicillin-susceptible and methicillin-susceptible Staphylococcus aureus, respectively.

This episode was edited by Julie Anne Justo, transcribed by Katie Lambert and Sarah Groom, and peer-reviewed by Megan Klatt and Lacy Worden. 

Note on conflict of interest for SNAP Data Safety Monitoring Committee (DSMC) members:

Conflicts of interest were evaluated when choosing individuals to serve on the SNAP DSMC. Aside from being compensated for their duties on the committee, DSMC members have no ongoing financial relationships that relate to the trial and are not involved in the conduct of the trial in any role other than that of a DSMC member. DSMC members have no intellectual conflict of interest or bias and reviewed SNAP data in a fully objective manner. 

Literature:

Steven Y. C. Tong, Joshua S. Davis, Emily Eichenberger et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015 Jul;28(3):603-61.

SNAP Adaptive trial platform/results of the PSSA & MSSA domains: 

• https://www.snaptrial.com.au/

ESCMID Global April 2025 presentation:

• www.online.escmid.org *
• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/

CloCeBa trial results (ESCMID Global April 2025 presentation): 

• www.online.escmid.org *
• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/

Note on access to online video of ESCMID Global presentations:

• In the six months following the congress:
  • Non-ESCMID members have access if they registered for ESCMID Global
  • Members have access only if they registered for ESCMID Global
• Six months after the congress:
  • Non-members do not have access, whatever their ESCMID Global registration status
  • All members have access, whatever their ESCMID Global registration status

CAMERA 2 trial: Steven Y. C. Tong, David C. Lye, Dafna Yahav, et al. Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA BacteremiaA Randomized Clinical Trial. JAMA. 2020;323(6):527-537. doi:10.1001/jama.2020.0103

 
POET trial: Kasper Iversen, Nikolaj Ihlemann, Sabine U. Gill et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med 2019;380:415-424

POET trial follow-up: Mia M. Pries-Heje, Christoffer Wiingaard, Nikolaj Ihlemann. Five-Year Outcomes of the Partial Oral Treatment of Endocarditis (POET) Trial. N Engl J Med 2022;386:601-602

In this episode of Communicable, hosts Angela Huttner and Annie Joseph join experts Kerrigan McCarthy of South Africa’s National Institute for Communicable Diseases and Natasha Crowcroft of the World Health Organisation to discuss the resurgence of measles as a consequence of misinformation campaigns and waning vaccination rates, how to diagnose and manage active measles cases, and post-exposure control measures to take to reduce further spread. They also address the broader challenges of the moment, including generalised vaccine hesitancy and sudden, sweeping budget cuts, underscoring the message that “measles anywhere is a problem everywhere.”

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. Anelia Zasheva of the Military Medical Academy, Sofia, Bulgaria.

ESCMID Global, ESCMID’s flagship congress, kicks off this Friday in Vienna. In light of that, Angela Huttner and Thomas Tängdén sit down with ESCMID leadership, President Robert Skov and Immediate-Past President Annelies Zinkernagel in this episode of Communicable. Together they discuss the roles of medical societies like ESCMID in shaping healthcare policy, the importance of scientific communication, and lessons learned from the COVID pandemic. The conversation highlights ESCMID’s priorities for the future on addressing antimicrobial resistance, fostering international collaboration and new educational initiatives. The episode also features personal anecdotes about what makes coming together at ESCMID Global so special. Tune in for a comprehensive look at how ESCMID is championing medical progress in infection for a healthier tomorrow.

This episode was edited by Kathryn Hostettler and not peer reviewed.

References

• Global impact of US policy changes: The ESCMID perspective. CMI Comms 2025;2(2): 105073.
• Malani AN, Sharland M, Clancy CJ, Skov R, ESCMID & IDSA Executive Boards. A global call to action to fight antimicrobial resistance: IDSA and ESCMID joint white paper. CMI Comms 2024; 1(2): 105033.
• Baghdadi JD & Morgan DJ. Diagnostic tests should be assessed for clinical impact. CMI Comms 2024; 1(2): 105010.

Communicable returns to the topic of gender dynamics in medicine in the second half of this special. This round, Angela Huttner wants to hear from the men, CMI Comms editors Marc Bonten, Josh Davis, Navaneeth Narayanan and Thomas Tängdén, about tackling issues like the evolving expectations at home and work, the impact of parental-leave policies, and the systemic biases that continue to shape careers. Personal anecdotes and reflections highlight both the progress made and the hurdles that still exist in striving for true gender equity in the medical profession. Editors Erin McCreary and Annie Joseph of CMI Comms also participate in the discussion, with Annie sharing an interesting follow-up to her story told in part 1.

In honour of International Women's Day, Communicable releases the first of a two-part special on gender dynamics within the fields of infectious diseases and clinical microbiology. Moderated by Angela Huttner, part 1 focuses on the women's perspectives, featuring CMI Comms editors Erin McCreary, Annie Joseph, and Huttner herself, who together reflect on personal experiences of gender bias in the workplace. They discuss differential (mis)treatment, break down common gendered situations in the workplace, and explore what individuals, institutes and society can do to promote a more inclusive, supportive environment for all. Editors Marc Bonten, Josh Davis, Navaneeth Narayanan and Thomas Tängdén of CMI Comms also join for part 1.

Several publications have described wondrous therapeutic effects of faecal microbiota transplant (FMT) on Clostridioides difficile infection. Yet the recent randomised trial assessing FMT in US veterans was terminated early for futility. In this episode, hosts Angela Huttner and Marc Bonten delve into the history, application, and complexities of FMT with experts Maria Vehreschild (Frankfurt University Hospital, Germany) and Dimitri Drekonja (Minneapolis Veteran Affairs Care System and University of Minnesota, US), who led the US trial. From the regulatory challenges and trial nuances to important new research, this conversation sheds light on a potentially revolutionary yet controversial treatment. 

Episode was edited by Kathryn Hostettler and peer-reviewed by Arjana Zerja (Mother Theresa University Hospital Centre, Tirana, Albania).

Other mentions:

• EurFMT
• European Directorate for the Quality of Medicines & HealthCare. Guide to the quality and safety of tissues and cells for human application. vol. 5th ed. EDQM Council of Europe; 2022. https://freepub.edqm.eu/publications/17/detail 

Literature

• Drekonja DM et al (2024) Clin Infect Dis, doi: 10.1093/cid/ciae467

Despite being preventable and curable, tuberculosis remains a major global health threat, infecting over 10 million people and claiming more than 1 million lives every year. In this episode of Communicable, hosts Angela Huttner and Navaneeth Narayanan discuss tuberculosis with experts Lorenzo Guglielmetti of Doctors without Borders and Olha Konstantynovska of Kharkiv National University, Ukraine. Key topics include the history, transmission, and pathophysiology of tuberculosis, as well as current diagnostic challenges and treatments for drug-resistant strains. The conversation highlights Lorenzo's work on the endTB project and Olha's experiences managing tuberculosis during the war in Ukraine. Despite advancements in treatment, the episode underscores the urgent need for political will and funding to combat this global health threat.

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. Maria Ana de Quadros Flores e Santos of Unidade Local de Saude Santa Maria, Lisbon, Portugal.

Abbreviations and terminology used in this episode:

• MSF: Médecins sans Frontières, or Doctors without Borders (msf.org)
• FIND: Foundation for Innovative New Diagnostics (www.finddx.org)
• ‘Intoxication symptoms’ are synonymous with ‘constitutional symptoms’ or ‘B symptoms’ of tuberculosis and include fever, night sweats, and unintentional weight loss. 

Literature:

• endTB Project
• Annual global tuberculosis report by WHO 2024 
• Dorman SE, et al. Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis. N Engl J Med 2021 doi: 10.1056/NEJMoa2033400
• Guglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. N Engl J Med 2025 doi: 10.1056/NEJMoa2400327

Sexually transmitted infections (STIs) affect millions globally daily, and multidrug-resistant strains are complicating treatment. Hosts Angela Huttner and Josh Davis welcome experts Dr. Teodora Elvira Wi from WHO and Professor Catriona Bradshaw from Monash University to discuss critical issues surrounding ‘super gonorrhoea,’ chlamydia, syphilis, Mycoplasma genitalium, and bacterial vaginosis. The episode reviews the latest epidemiology and highlights the need to innovate diagnostics and treatment options, destigmatise STIs, and promote people-centred healthcare strategies to manage and prevent these infections. 

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania.  

Literature:

Guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; 2021.

Chris Kenyon et al. on screening impact for gonorrhoea and chlamydia infections in key populations The Lancet HIV 2024.