The Pulse - July 2026

Greetings Readers! In this monthly edition, we examine 3 practice changing studies.

Is there a better option than IV Vancomycin for MRSA Infective Endocarditis?

The study answering this question was covered this month in Premium Pulse.

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1. Carbapenems Finally Go P_rO: A New Exit Strategy for cUTI  

   Tebipenem pivoxil is the first FDA-approved oral carbapenem for adults with complicated UTI, including pyelonephritis, who have few or no alternative oral treatment options. In a randomized trial of hospitalized patients with cUTI, oral tebipenem achieved clinical cure rates comparable to IV imipenem-cilastatin, including in infections caused by ESBL-producing Enterobacterales. The approval opens the door to earlier hospital discharge—or even avoiding admission altogether—for carefully selected patients who would otherwise require IV therapy. Just remember: while an oral carbapenem may rescue your Friday afternoon discharge plans, antimicrobial stewardship will be working overtime to ensure convenience today doesn't become carbapenem resistance tomorrow. Hong D. Not Yet Published.

   Study Type: international, multicenter RCT of 1690 adults with complicated UTI randomized to oral vs IV carbapenem treatment.

   Link

2. Skip the Warm-Up: Is 12 mg the Better First Dose for SVT?

   For hemodynamically stable patients with regular narrow-complex SVT, this prospective observational study suggests that starting with 12 mg of adenosine may be more effective than the guideline-recommended 6 mg dose, achieving first-dose conversion in 83% versus 52% of patients (NNT = 4) without increasing adverse effects. Although the study was nonrandomized and conducted at a single center, the findings align with prior retrospective data favoring a higher initial dose. Patients receiving 12 mg also trended toward fewer SVT recurrences during their ED stay. Until randomized trials provide definitive guidance, an upfront 12-mg strategy may be a reasonable consideration in selected patients—and could spare them the unique pleasure of experiencing adenosine’s "impending doom" sensation twice. Sert ET, et al. Acad Emerg Med 2026 May. 

   Study Type: prospective observational study conducted at a single center in Turkey of 142 adult patients in the ED with SVT, categorized to either 6 mg or 12 mg dose of adenosine with propensity score matching.

   Link

3. Prepare for Trouble, and Make It Double: IBD and Concurrent C. diff

   Patients with IBD are uniquely vulnerable to C. difficile, making any new or worsening diarrhea a reason to test—even without recent antibiotics or prior colectomy. The AGA recommends a two-step diagnostic approach (PCR/GDH plus toxin assay) and favors fidaxomicin over vancomycin to reduce recurrences, while leaving metronidazole on the sidelines. Importantly, don't hit pause on IBD therapy: if an IBD flare is suspected, immunosuppressive treatment can proceed alongside CDI management, and persistent symptoms after 48–72 hours should prompt endoscopic evaluation for uncontrolled inflammation or CMV. For patients with recurrent CDI, microbiome-based therapies have moved into the spotlight, whereas probiotics remain unsupported.

   Study Type: Expert Review from American Gastroenterological Association (AGA) Clinical Practice Update on Management of Clostridioides difficile Infection in Inflammatory Bowel Disease

   Link

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