It's easy to bash twitter these days, and for relatively good reasons
However, the live-tweeting from ESCMID has been incredible - I've learned loads of new stuff from following this (and some great discussions ongoing)
Not what it used to be, but still the best
🔥 Late Breakers
SNAP platform RCT| Adjunctive Clindamycin in S.aureus bacteraemia
❌ No mortality benefit
90d mortality:16.9% vs 15.2% aOR 1.16 (CrI cross 1)
📊PPSup(~7%)→Futility threshold reached
⚠️ICU subgp:numerically worse with clinda
⚖️CDAD:no # (~2%)😯
#ESCMIDGlobal2026
it's crazy how you can have a full on, capital A Addiction to caffeine (need it to function, get withdrawal without it, last thing you think of before going to sleep, first thing you think of when you wake up) and it's just totally fine. even better than fine. it's good.
Looking forward to speaking at this event in June!
After 6y of out if hours shifts in Southampton children’s ED it holds a special place in my heart ❤️
Nice to see this published
Archives of Disease in Childhood: Publishing papers to impact on practice 1926–2026 https://adc.bmj.com/content/111/5/391
@pier_network @UHSFT @unisouthampton @RCPCHtweets @BSPGHAN @SotonChildHosp
The British Medical Association and Jolyon Maugham KC in the mud
I know there’s a lot of shit going on in the world atm BUT the move to that vacuum packed mince packaging seriously needs investigating
Does anything need iv antibiotics?
My latest post looks at early childhood infections
There’s some infections you simply can’t avoid
So when’s the best time to get them?!
People tend to think in one of two way - and both are wrong!
https://open.substack.com/pub/alasdairmunro/p/what-people-get-wrong-about-early?r=1fhhmw&utm_medium=ios
Avoiding infections is good 👍
But some simply cannot be avoided - multiple exposures over the life course is inevitable
In which case, when is the best time to get infected for the first time? 🤔
https://open.substack.com/pub/alasdairmunro/p/what-people-get-wrong-about-early?r=1fhhmw&utm_medium=ios
The jagged frontier with LLMs is so weird
2 tasks I thought they’d excel at both failed in the past 2 days
1. Exporting multiple emails from outlook into one single document
2. Formatting an author list and affiliations based on a spreadsheet
Should’ve just done it manually!
Group A Strep caused a lot of drama in 2022, with an unprecedented spike in scarlet fever and invasive infections
Ever wondered what happened after that?
We're currently in peak GAS season - rates are the lowest they've been since the pandemic 🔥
https://www.gov.uk/government/publications/group-a-streptococcal-infections-seasonal-activity-in-england-2025-to-2026/group-a-streptococcal-infections-second-update-on-seasonal-activity-in-england-2025-to-2026
Thanks for this great breakdown @apsmunro on the new surviving sepsis guideline. I suspect the withdrawal of the sepsis tool recommendation is going to ruffle some feathers.
R to @apsmunro: There's some more stuff about vasopressors and ECMO if you're into that kind of thing 🤪
Key takeaways from the new guidelines:
- Recommendation to perform sepsis screening is removed (good)
- Continuous beta-lactams not yet recommended (but should be)
9/end
R to @apsmunro: All the vitamins continue to be recommended against
Helpfully reminding us of why RCT's are so vital in this type of domain and why we must remain sceptical of observational, or "real world", evidence (looking at you vitamin C)
8/
R to @apsmunro: Procalcitonin for antibiotic de-escalation is out (in the setting of strong antimicrobial stewardship programs)
No surprise here given no evidence of benefit found in the BATCH RCT (of which the lead investigator is an author of these guidelines)
7/
R to @apsmunro: The next part, I understand but disagree with
The authors suggest there is insufficient evidence to recommend continuous beta-lactam infusions
Here's why I think this is wrong
5/
R to @apsmunro: Adult evidence now clearly points to *mortality* benefit of around 10% - this is huge
The paediatric evidence is consistent with this, but the certainty is much weaker
The risks of doing this in critically ill children is zero
Why would you not?
6/
https://www.sciencedirect.com/science/article/pii/S0022347624003238
R to @apsmunro: Many children present to ED febrile and looking dreadful - very few have sepsis, but those who do often look indistinguishable from those who don't AT FIRST
This extended window allows time to investigate and observe the trend in illness - key in preventing overtreatment
4/
R to @apsmunro: The wording on antibiotic timing has been updated
The last version already introduced a longer window for antibiotic administration to enable time to establish diagnosis - this update emphasises using this time to investigate
This bit is key...
3/
R to @apsmunro: Sepsis screening in children has, IMO, been a debacle
Tools perform extremely poorly and are frequently felt to cause more harm than good
@Damian_Roland and I have argued for some time this process needs completely rethinking
3/
https://www.bmj.com/content/381/bmj.p1327.long
R to @apsmunro: First the good news
The guidelines have REMOVED the recommendation to institute sepsis screening
The evidence is too muddy to demonstrate this is worthwhile
This has been supplemented by "recommending" hospitals institute quality improvement programs
2/
The new surviving sepsis guidelines are out
The adult guidelines are already taking a battering (including ACEP refusing to endorse 😬)
The paediatric guidelines are actually more interesting
Some thoughts
1/
https://journals.lww.com/pccmjournal/fulltext/9900/surviving_sepsis_campaign_international_guidelines.651.aspx
R to @apsmunro: If you want to know more about meningococcal disease and this recent outbreak, I have written an explainer in my newsletter which can be found at the link below
https://open.substack.com/pub/alasdairmunro/p/menb-or-not-menb-that-is-the-question?utm_campaign=post-expanded-share&utm_medium=web
A short, but dramatic outbreak of meningococcal disease - glad that it all seems to be winding down
Huge thanks to the incredibly hard working people at @UKHSA who organised the response with vaccination and prophylactic antibiotics 🙏
What do we mean when we say 'meningitis'
https://youtube.com/shorts/4ibw5vuP0Gw
(also recommend this excellent blog from @apsmunro
https://alasdairmunro.substack.com/p/menb-or-not-menb-that-is-the-question)
#meningitis
Don't miss out... Read it, share it, save it, understand it...
How the Covid legacy shaped the meningitis response: A frightened generation shaped by lockdown; misinformation; the need to attribute blame; a communications challenge for public health officials & misplaced belief that medicine can eliminate all risk
https://www.newstatesman.com/politics/health/2026/03/was-kent-prepared-for-meningitis
My new post looks at the current meningococcal outbreak in south east England
What is meningococcus?
What's happening with the outbreak?
What's the deal with the vaccines?
https://open.substack.com/pub/alasdairmunro/p/menb-or-not-menb-that-is-the-question?utm_campaign=post-expanded-share&utm_medium=web
This is a brilliant article on Meningitis B by Alasdair Munro - a senior clinical research fellow in paediatric infectious disease. He runs clinical trials and study infections in children, including Covid-19. https://alasdairmunro.substack.com/p/menb-or-not-menb-that-is-the-question
If the children’s module does the same as this one, and simply vindicates what we already knew and planned to deliver, I will require veterinarian levels of sedation to get through it
Another wonderful summary from @apsmunro on the current situation of the MenB outbreak in the UK.
Please make sure you read carefully and share if you believe it will be useful for someone.
#pedsID #menBoutbreak @ESPIDsociety @seipweb
https://open.substack.com/pub/alasdairmunro/p/menb-or-not-menb-that-is-the-question?utm_source=direct&utm_campaign=post-expanded-share&utm_medium=web
From today, the NHS will offer free chickenpox vaccinations as part of its routine childhood immunisation programme.
This will keep more children well and in school, protecting them from a disease that can be serious, and reduce the time parents take off work to care for them.
This issue of Calvin and Hobbes lives rent-free in my mind
Why should someone have to be afebrile to receive oral antibiotics? Are iv antibiotics better fever reducers? What if I gave Tylenol with the oral antibiotics? This is traditional, non evidence-based “because we said so” nonsense, typical of shmidelines.
If I remember the evidence for Tamil right it clearly showed that it could reduce how long flu symptoms lasted from 7 days to 1 week.
My two paragraph summary of my ignorance about covid, and why I think we should find clever ways to test stuff more.
To see how unbelievably stupid this is, consider the following is equally true
“The statement “vaccines don’t cause people to turn into sweetcorn” is not an evidence based claim because studies have not ruled out the possibility that vaccines cause people to turn into sweetcorn”
Respiratory PCR testing has exploded since the pandemic, but tests are expensive and sometimes used indiscriminately
We produced a statement for our regional network to help guide testing and improve diagnostic stewardship
https://www.piernetwork.org/guidelines-respiratory-pcr-testing.html