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From random care to randomized clinical trials of patients with invasive streptococcal infections—research prioritisation and areas of equipoise

Life-threatening invasive infections caused by Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis (SDSE) are unpredictable, frequently fatal, and are increasing in incidence globally. In the absence of evidence from randomized controlled trials (RCTs), clinical management for these conditions varies. Understanding current management approaches and areas of clinical equipoise will inform planning of feasible high-impact RCTs.

Is Systemic Dissemination of BCG Following Neonatal Vaccination Required for Protection Against Mycobacterium tuberculosis?

Tuberculosis (TB) is caused by Mycobacterium tuberculosis (Mtb) and is a leading cause of death. BCG is the only licensed TB vaccine. Preclinical studies have shown that in adults, intravenous administration of BCG improves protection against TB. We hypothesize that intradermal administration of BCG to the human newborn leads to low-grade BCG bacteremia and that this systemic dissemination improves protection against Mtb infection. This hypothesis is based on supporting observations including animal and human studies. It is a testable hypothesis and offers to deliver immediately actionable insight to advance the global efforts against TB.

Unpacking the “black box” of safe respiratory physiotherapy interventions delivered in the home for children with cerebral palsy and medical complexity

Describe the physiotherapy interventions provided to children with cerebral palsy at risk of respiratory illness and determine criteria for safe in-home treatment.

Challenges and insights in self-swab surveillance for asymptomatic Streptococcus pyogenes carriage

Asymptomatic carriage of Streptococcus pyogenes (Strep A) may contribute to transmission, yet its role remains poorly understood and evidence on optimal detection methods is limited. While self-collected throat swabs are used in infectious disease surveillance, their value for identifying asymptomatic Strep A carriage in adults is uncertain. This pilot prospective cohort study, conducted at a Perth medical research institute between August and October 2024, assessed feasibility and acceptability of self-collection, with sensitivity as a secondary objective. 

Safety, tolerability, and pharmacokinetics of a 2 g subcutaneous dose of ceftriaxone as an alternative to intravenous delivery

Subcutaneous delivery of antibiotics is a practical alternative to intravenous administration. Ceftriaxone is commonly used for a variety of infections with limited data on the safety and pharmacokinetics of a 2 g subcutaneous dose. This was a prospective, self-controlled cross-over study in 20 stable inpatients receiving ceftriaxone for their infection. Following an intravenous dose, participants received a single dose of 2 g subcutaneous ceftriaxone, in 50 mL normal saline via gravity feed.

TrialR: critical enablers and the need for reusable Rare Disease Clinical Trial infrastructure in Western Australia

Citation: MacDonald B, Burmaz M, Baker S, et al. TrialR: critical enablers and the need for reusable Rare Disease Clinical Trial infrastructure in

Determinants of secondary prophylaxis for childhood rheumatic heart disease in Ethiopia: A qualitative study of children and caregivers

Rheumatic heart disease remains a major public health challenge in Ethiopia, particularly among children. Monthly intramuscular benzathine penicillin G is the cornerstone of secondary prophylaxis, yet adherence and delivery are suboptimal. This study explores the lived experiences of children and adolescents with RHD, capturing their direct voices and those of their caregivers to understand determinants of secondary prophylaxis uptake.

Burden and Experiences of Head Lice Infestation Among Children in Western Australia

Head lice is an ectoparasitic skin infection commonly seen in primary school-aged children. In remote Australia, where rates of other skin infections and downstream sequelae are endemic, the rate of head lice infestation is unknown.

Identifying Gaps in the International Consensus Case Definitions for Invasive Aspergillosis: A Review of Clinical Cases Not Meeting These Definitions

International consensus definitions for invasive aspergillosis (IA) in research are rigorous, yet clinically significant cases are often excluded from clinical studies for not meeting proven/probable IA case definitions. To better understand reasons for the failure to meet criteria for proven/probable infection, we herein review 47 such cases for their clinical and microbiological characteristics and outcomes. 

Trimodal skin health programme for childhood impetigo control in remote Western Australia (SToP): a cluster randomised, stepped-wedge trial

Skin infections affect physical health and, through stigma, social-emotional health. When untreated, they can cause life-threatening conditions. We aimed to assess the effect of a holistic, co-designed, region-wide skin control programme on the prevalence of impetigo.