Dalbavancin Offers a Simplified IV Option for Staphylococcus aureus Bacteremia
Staphylococcus aureus bacteremia is a serious bloodstream infection that typically requires 4 to 8 weeks of intravenous (IV) antibiotics. Dalbavancin is a long-acting IV antibiotic with potential to simplify bacteremia treatment by eliminating the need for extended IV therapy. The Dalbavancin as an Option for Treatment of S. aureus Bacteremia (DOTS) trial was a phase 2b, multicenter, randomized study comparing dalbavancin with standard antibiotic therapy in adult patients hospitalized with complicated S. aureus bacteremia who had cleared their blood cultures after initial treatment.
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In this open-label trial, patients received at least 72 hours (but no more than 10 days) of initial antibacterial therapy before being randomized to receive either two doses of IV dalbavancin (1500 mg on days 1 and 8) or standard IV therapy for 4 to 8 weeks (antistaphylococcal penicillin or cefazolin if methicillin susceptible; vancomycin or daptomycin if methicillin resistant). The primary endpoint was the desirability of outcome ranking (DOOR) at day 70, which included clinical success, infection and safety complications, mortality, and health-related quality of life. Also, the primary analysis assessed whether dalbavancin was superior to standard therapy, defined as a greater than 50% probability of having a better DOOR outcome (95% CI). Secondary outcomes included clinical efficacy and safety.
Of 200 study patients, 167 (84%) survived to day 70 and were evaluated for treatment efficacy. Patients without a day 70 assessment were considered treatment failures. The probability of a better day 70 outcome with dalbavancin compared with standard therapy was 47.7% (95% CI, 39.8–55.7%). Clinical efficacy was similar between groups: 73 of 100 patients treated with dalbavancin and 72 of 100 treated with standard therapy (95% CI, –11.5% to 13.5%), which met the trial's noninferiority requirement. Serious adverse events occurred in 40% of patients in the dalbavancin group and 34% in the standard therapy group. Treatment-related adverse events were uncommon in both groups.
In adults with complicated S. aureus bacteremia who had cleared their blood cultures, dalbavancin was not better than standard antibiotic therapy. Efficacy and safety were similar between groups. Dalbavancin may still be a practical alternative to prolonged IV therapy, offering a simpler treatment option for appropriate patients. (Turner, N.A., et al. [2025]. Dalbavancin for treatment of Staphylococcus aureus bacteremia: The DOTS randomized clinical trial. JAMA. Advance online publication. Retrieved August 2025 from https://jamanetwork.com/journals/jama/article-abstract/2837604)
Released: September 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Multidose Ondansetron Reduces Severity of Gastroenteritis in Children After Emergency Department Visits
Vomiting from acute gastroenteritis is a common cause of emergency department (ED) visits in children. Single-dose oral ondansetron is often given in the ED to reduce vomiting and facilitate oral rehydration. However, evidence for continued ondansetron use after discharge has been limited. A randomized trial evaluated whether providing caregivers with multiple doses of ondansetron after an ED visit could reduce the severity of gastroenteritis in children during the following week.
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In a double-blind, placebo-controlled superiority trial, 1030 children aged 6 months to under 18 years presenting with gastroenteritis-related vomiting were enrolled at six pediatric emergency departments. Caregivers were given six doses of oral ondansetron or placebo to administer as needed for vomiting during the first 48 hours after discharge. The primary outcome was moderate-to-severe gastroenteritis, defined as a modified Vesikari score of 9 or higher (scores ranges from 0 to 20 with higher scores indicating greater severity) within 7 days. Secondary outcomes included number and duration of vomiting episodes, unscheduled physician visits, intravenous fluid administration, and adverse events.
Moderate-to-severe gastroenteritis occurred in 5.1% of children who received ondansetron versus 12.5% who received placebo, representing a significant risk reduction (adjusted odds ratio, 0.50; 95% CI, 0.40–0.60). Although the presence and duration of vomiting were similar between groups, children who received ondansetron had fewer vomiting episodes in the first 48 hours (adjusted rate ratio, 0.76; 95% CI, 0.67–0.87).
There were no meaningful differences in unscheduled health care visits, need for IV fluids, or adverse events between the two groups. Ondansetron was well tolerated, and safety profiles were similar.
These findings support the short-term use of ondansetron at home after ED discharge for pediatric gastroenteritis-associated vomiting. Nurses can educate families on appropriate dosing and reinforce that this strategy may help reduce illness severity without increasing risk. (Freedman, S. B., et al. [2025]. Multidose ondansetron after emergency visits in children with gastroenteritis. NEJM, 393[3], 255–266. Retrieved August 2025 from https://www.nejm.org/doi/full/10.1056/NEJMoa2503596)
Released: September 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Behavioral Therapy is as Effective as Solifenacin for Overactive Bladder in Parkinson Disease
Overactive bladder (OAB) symptoms are common and distressing in patients with Parkinson disease (PD) and can significantly affect quality of life. Drug treatments such as solifenacin may help, but they often cause side effects that worsen PD-related morbidity. Behavioral strategies, including pelvic floor muscle training, may provide a safe, non-drug alternative.
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A 12-week, randomized noninferiority trial evaluated whether behavioral therapy could provide similar benefit of solifenacin therapy without medication-related risks. This study enrolled participants with PD and moderate-to-severe OAB symptoms between 2018 and 2023 across four U.S. Veterans Affairs health systems. Participants received either behavioral therapy (pelvic floor muscle training and urge suppression techniques delivered by a nurse practitioner) or daily solifenacin (5–10 mg). The primary outcome was symptom severity at 12 weeks, measured by the International Consultation on Incontinence Questionnaire–OAB (ICIQ-OAB) module. A 15% noninferiority margin was prespecified. Adverse events were assessed every 2 weeks for 8 weeks and again at 12 weeks.
Seventy-seven participants with PD (mean age 71 years; 84% male) were randomized to behavioral therapy (n = 36) or solifenacin (n = 41). A total of 73 participants completed the study, with four dropouts in the drug group. Baseline characteristics, including cognition and OAB symptom scores, were similar between groups.
At 12 weeks, both groups showed clinically meaningful improvement in OAB symptoms, and the difference between behavioral and drug therapy remained within the predefined 15% noninferiority margin (mean score: drug 5.8, behavioral 5.5; P = .02). Adverse events were more frequent in the drug group. Dry mouth and falls occurred more often with solifenacin, while the behavioral group experienced fewer complications overall.
These findings support the use of pelvic floor muscle training and urge suppression strategies as a first-line, non-drug option for managing OAB symptoms in people with PD. Nurses and nurse practitioners can play a central role in delivering this safe and effective therapy, helping reduce reliance on medications that may worsen PD-related risks. (Vaughan, C. P., et al. [2025]. Behavioral compared with drug therapy for overactive bladder symptoms in Parkinson disease: A randomized noninferiority trial. JAMA Neurol. Advance online publication. Retrieved August 2025 from https://doi.org/10.1001/jamaneurol.2025.1904)
Released: September 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Spironolactone Does Not Reduce Cardiovascular Events in Patients Receiving Maintenance Dialysis
Patients with kidney failure on maintenance dialysis are at high risk for heart failure and cardiovascular-related death. The ACHIEVE trial (Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease) tested whether spironolactone 25 mg daily could reduce these risks. Spironolactone, a mineralocorticoid receptor antagonist, is known to reduce cardiovascular events in other populations but its effectiveness in dialysis patients has been unclear.
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This international, randomized, controlled trial was conducted in 143 dialysis programs across 12 countries. Patient enrollment and screening for inclusion was conducted from September 2017 to October 2024. Eligible patients were age 45 years or older, or 18 years or older with diabetes, and had been on dialysis for at least 3 months. All participants completed an open-label run-in phase to ensure they could tolerate spironolactone before randomization. Patients were randomized 1:1 to receive either spironolactone or placebo. Participants, clinicians, and outcome assessors were blinded to treatment assignment. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. Secondary outcomes included all-cause death and all-cause hospitalization.
Of 3,689 patients screened for inclusion, a total of 2,538 patients were randomly assigned to spironolactone (n = 1260) or placebo (n = 1278). Median follow-up was 1.8 years. The trial was stopped early for futility after interim analysis. The primary outcome occurred in 258 participants in the spironolactone group and 276 in the placebo group (hazard ratio 0.92; 95% CI, 0.78–1.09; p = 0.35). All-cause mortality and all-cause hospitalizations were also similar between groups.
These findings show that spironolactone did not reduce cardiovascular mortality or heart failure hospitalizations in patients receiving maintenance dialysis. Nurses should be aware that spironolactone offers no clear cardiovascular benefit in this population, and future research will need to explore alternative approaches to lower cardiovascular risk in dialysis patients. (Walsh, M., et al. [2025]. Spironolactone versus placebo in patients undergoing maintenance dialysis (ACHIEVE): an international, parallel-group, randomised controlled trial. Lancet, 406[10504], 695–704. Retrieved August 2025 from https://doi.org/10.1016/S0140-6736(25)01198-5)
Released: September 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.