This Week in Infectious Disease: COVID-19 Treatments and Tuberculosis

From the New England Journal of Medicine, a trial examined the efficacy of metformin, fluvoxamine, or ivermectin versus placebo for non-hospitalized adults with SARS-CoV-2 infection ^[1].

The study involved 1323 participants, yet no primary or secondary outcome results were reported in the source data, leaving clinicians to note the absence of reported efficacy or safety findings for these specific treatments. Meanwhile, another study from the New England Journal of Medicine looked at nirmatrelvir-ritonavir in community-based trials involving higher-risk adults ^[2].

While viral load decreased by the end of treatment, the authors describe that adding the drug to usual care did not reduce the incidence of hospitalization or death within 28 days. The authors also note that effectiveness in vaccinated or previously infected individuals remains unclear due to trial design limitations.

Elsewhere this week, research in medRxiv explored strategies to curb antibiotic consumption. A cluster randomised controlled trial across 44 villages in Burkina Faso and the Democratic Republic of Congo compared a community-based behavioural intervention bundle with a control group ^[3].

The intervention significantly reduced Watch-group antibiotic use over nine months, though the authors suggest these observational community-level changes should be interpreted cautiously in practice.

A separate study in medRxiv addressed tuberculosis epidemiology through a systematic review and meta-analysis ^[4].

This analysis evaluated bacteriologically-confirmed tuberculosis prevalence in 264,530 people across Southern and Eastern Africa. Results indicate higher prevalence among participants living with versus without HIV, with a relative risk of 3.86. However, authors note limited information on prevalence differences and wide credible intervals for notification-to-prevalence ratios. Finally, a narrative review in Frontiers in Medicine discussed natural product-based plasmid curing agents as an alternative to traditional bactericidal antibiotic strategies ^[5].

The authors highlight a noted therapeutic window paradox as a key limitation, synthesizing arguments regarding these agents without reporting specific clinical outcomes or safety data.