Issue: Newsletter 21 | June 1, 2026
| Citation of Articles | PICO | Main Results | Risk of Bias |
|---|---|---|---|
| De Cock PA, Colman R, Smits A, Piersigilli F, Renard M, Van Damme A, et al. Bedside model-informed precision dosing of vancomycin in severely ill neonates and children in Belgium (the BENEFICIAL trial): a multicentre, randomised controlled trial. Lancet Child Adolesc Health. 2026 Jun;10(6):406-17. doi:10.1016/S2352-4642(25)00385-2 |
P: 314 critically ill paediatric patients (<18 years) in intensive care or haemato-oncology units receiving intravenous vancomycin for suspected or confirmed Gram-positive infection I: Model-informed precision dosing (MIPD) of vancomycin using Bayesian software with early therapeutic drug monitoring and AUC-guided dosing adjustments C: Standard-of-care therapeutic drug monitoring (TDM) of vancomycin O: Achievement of 24-h AUC-to-MIC ratio target of 400–600 mg·h/L at 24–48 h; acute kidney injury or all-cause mortality; serious adverse events |
MIPD significantly improved target AUC-to-MIC attainment at 24–48 h compared with standard TDM (71.8% vs 53.9%; absolute difference 18.9%, 95% CI 1.7–34.7). Acute kidney injury or all-cause mortality was numerically lower in the MIPD group but not statistically significant (12.4% vs 16.9%; absolute difference –4.5%, 95% CI –11.6 to 3.5). Serious adverse events occurred at similar rates in both groups (5% each). Overall, AUC-guided MIPD improved pharmacokinetic target attainment with low risk of harm. | Moderate risk: The open-label design for treating clinicians and pharmacists could introduce performance bias, although randomisation, allocation concealment, and masking of patients, families, and biostatisticians reduce selection and detection bias. Objective pharmacokinetic outcomes strengthen internal validity. Exclusion of patients without deferred consent completion and incomplete availability of AUC data may introduce some attrition bias, though overall follow-up and safety reporting were robust. |
| Vissing NH, Skajaa T, Grosen D, Albertsen BK, Als-Nielsen B, Hasle H, et al. Early discontinuation of empirical antibiotics versus extended treatment in children with cancer and high-risk febrile neutropenia in Denmark: an open-label, randomised controlled trial. Lancet Child Adolesc Health. 2026 Jun;10(6):418-28. doi:10.1016/S2352-4642(26)00039-8 |
P: 88 febrile neutropenia episodes in 70 children with cancer aged 0–17 years receiving intensive chemotherapy and experiencing high-risk febrile neutropenia without microbiologically documented infection I: Early discontinuation of intravenous antibiotics after 48 h of defervescence and clinical stability regardless of neutrophil recovery C: Continuation of intravenous antibiotics until neutrophil recovery or a maximum of 10 days O: Duration of antibiotic exposure within 28 days; infection-related serious adverse events including bacteraemia, focal infection, sepsis, and death |
Early discontinuation of antibiotics significantly reduced antibiotic exposure compared with standard continuation therapy, with a mean antibiotic duration of 8.1 days versus 13.5 days, respectively (estimated difference –4.0 days, 95% CI –6.0 to –1.9; p=0.0002). Serious adverse events occurred at similar rates between groups (22% vs 21%; risk ratio 1.06, 95% CI 0.46–2.47), and no deaths occurred. Overall, early discontinuation reduced unnecessary antibiotic use without evidence of compromised short-term safety. | Moderate risk: The open-label design could introduce performance bias, although allocation concealment and computer-generated randomisation strengthen internal validity. The small sample size and low event rates limit statistical power to detect rare safety outcomes. Use of febrile episodes rather than unique patients may introduce clustering effects, potentially affecting independence of observations and generalisability. |
|
Hay AD, Abbs S, Ridd M, Granier S, Lane JA, Muir P, et al. Rapid respiratory microbiological point-of-care testing and antibiotic use in primary care: a randomized clinical trial. JAMA Intern Med. 2026 May 18; doi:10.1001/jamainternmed.2026.1426 • Editorial Commentary: Linder JA, Szymczak JE. Acute respiratory infections in primary care—precision microbiology fails to bring order to diagnostic disarray. JAMA Intern Med. 2026 May 18; doi:10.1001/jamainternmed.2026.1440 |
P: 552 children and adults aged ≥12 months presenting to primary care with acute respiratory tract infection (≤21 days) where antibiotics were considered potentially necessary I: Rapid multiplex microbiological point-of-care testing (RM-POCT) detecting 19 respiratory viruses and 4 atypical bacteria with results available in approximately 45 minutes C: Usual care without RM-POCT O: Same-day antibiotic prescribing; patient-reported symptom severity on days 2–4 |
RM-POCT did not reduce same-day antibiotic prescribing compared with usual care, with antibiotics prescribed to 45% of participants in both groups (OR 1.00, 95% CI 0.71–1.41; p>0.99). There was no significant difference in symptom severity on days 2–4 between groups (difference in means 0.09, 95% CI –0.10 to 0.27; p=0.36). Prespecified subgroup analyses showed reduced antibiotic prescribing among patients with a detected viral pathogen (OR 0.35, 95% CI 0.20–0.63; interaction p<0.001) and those with chronic lung disease (OR 0.55, 95% CI 0.28–1.09; interaction p=0.046). Overall, RM-POCT did not improve overall antibiotic prescribing but appeared beneficial in selected subgroups without worsening clinical outcomes. | Moderate risk: The open-label nature for clinicians and patients could introduce performance bias, although outcome assessors and statisticians were masked to allocation. The primary outcome was objective and available for all participants, minimizing attrition bias. Safety outcome completion rates were moderate (74–78%), which may introduce some response bias. Subgroup findings should be interpreted cautiously as the study was not primarily powered for these analyses. |
| Denninghoff KR, Casper TC, Zorc JJ, Ruddy RM, Satola S, Wendt WJ, et al. Azithromycin for preschoolers with wheezing in the emergency department. N Engl J Med. 2026 May 18; doi:10.1056/NEJMoa2516505 |
P: 840 preschool children aged 18–59 months presenting to emergency departments with moderate-to-severe wheezing episodes; 521 were nasopharyngeal pathogen-positive for Streptococcus pneumoniae, Moraxella catarrhalis, or Haemophilus influenzae I: Azithromycin 12 mg/kg once daily for 5 days C: Matching placebo for 5 days O: Severity of wheezing symptoms measured by Asthma Flare-up Diary for Young Children (ADYC) over 5 days; secondary outcomes included ED/hospital length of stay, return visits, bacterial clearance, and antimicrobial resistance |
Azithromycin did not reduce wheezing severity compared with placebo in either pathogen-positive or -negative cohorts. ADYC scores were similar between azithromycin and placebo groups in the positive cohort (median 9.59 vs 9.72; P=0.70) and negative cohort (9.30 vs 9.10; P=0.69). Despite significantly higher bacterial clearance in the azithromycin group (58.7% vs 11.4% in placebo among positives), this did not translate into improved clinical outcomes. Secondary outcomes, including healthcare utilization, resistance development, and adverse events, were also similar. | Low–moderate risk: Randomised, placebo-controlled, multicentre design with clear allocation to azithromycin vs placebo reduces selection and performance bias. Outcome assessment used standardized diary scoring, limiting detection bias. Early stopping for futility may reduce power for detecting smaller effects. Stratified analysis by bacterial status strengthens internal validity but increases risk of multiple subgroup comparisons. Overall attrition and safety reporting appear adequate. |
| Portero-Prados FJ, Pabón-Carrasco M, Ponce-Blandón JA. Effectiveness of chlorhexidine gluconate–impregnated dressings in preventing central line–associated bloodstream infection in a paediatric intensive care unit: a randomised controlled trial. Intensive Crit Care Nurs. 2026 May 7; doi:10.1016/j.iccn.2026.104441 |
P: 250 paediatric patients admitted to a tertiary paediatric intensive care unit with central venous catheters (125 per group) I: Chlorhexidine gluconate (CHG)-impregnated central line dressings C: Conventional transparent dressings O: Central line–associated bloodstream infection (CLABSI) incidence; skin reactions; catheter-related risk factors including dwell time and vaccination status |
CHG-impregnated dressings significantly reduced CLABSI incidence compared with conventional dressings (2.4% vs 18.4%; p<0.001). In multivariable analysis, CHG dressings remained independently protective against CLABSI (OR 0.15, 95% CI 0.04–0.58). Longer catheter dwell time increased infection risk (OR 1.13 per day, 95% CI 1.04–1.22), and incomplete vaccination status was associated with higher CLABSI risk (OR 8.68, 95% CI 2.48–30.47). Mild skin reactions were more frequent in the CHG group (16.8% vs 11.2%), particularly in younger infants, but did not require catheter removal. Overall, CHG dressings reduced infection risk with acceptable safety. | Moderate risk: Single-blind design may introduce performance bias, as clinicians were likely aware of dressing type. Randomisation and multivariable adjustment strengthen internal validity, but residual confounding cannot be excluded. Single-centre PICU setting limits generalisability. Outcome definition (CDC/NHSN CLABSI criteria) is standardized, reducing detection bias. Slight imbalance in skin reaction reporting may reflect partial unblinding. |
| Faust K, Strecker F, Haug C, Felderhoff-Müser U, Stein A, Jensen R, et al. Extended barrier precautions vs hand hygiene alone and neonatal sepsis in intensive care patients: the BALTIC cluster-randomized clinical trial. JAMA Netw Open. 2026 May;9(5):e2612759. doi:10.1001/jamanetworkopen.2026.12759 |
P: 9731 neonates requiring intensive care across 12 tertiary neonatal intensive care units in Germany (cluster-randomized crossover design across 24 clusters) I: Standard hand hygiene disinfection alone for infants colonized with third-generation cephalosporin–resistant gram-negative bacteria (3GCR-GNB) C: Standard hand hygiene plus extended barrier precautions (gloves and gowns) for routine care O: Health care–associated gram-negative bloodstream infections (primary outcome); transmission of 3GCR-GNB; overall infection rates |
Standard hand hygiene was noninferior to extended barrier precautions for prevention of gram-negative bloodstream infections. Infection rates were identical between groups (0.5% vs 0.5%; risk difference −0.03%, 95% CI −0.43 to 0.38; noninferiority P<0.001). Transmission events were also similar between strategies (2.5% vs 3.0%; risk difference −0.44%, 95% CI −2.47 to 1.58). Overall infection rates did not differ meaningfully between groups (2.1% vs 2.0%). These findings indicate no added benefit of routine gown-and-glove precautions over standard hand hygiene in this setting. | Low–moderate risk: Strong cluster-randomized crossover design across multiple NICUs with large sample size enhances external validity. Prespecified noninferiority margin and CONSORT-adherent reporting strengthen methodological rigour. Lack of individual-level randomisation may introduce cluster-level confounding, though crossover design mitigates this. Open-label nature is unavoidable but outcome (bloodstream infection) is objective and registry-defined, reducing detection bias. Some potential for implementation variability across sites. |
| Chang VWL, Li Q, Barnes D, Byrne AL, Cho JG, Foo SW, et al. Three months of weekly rifapentine and isoniazid versus four months of daily rifampicin for tuberculosis infection: a randomized controlled trial. Clin Infect Dis. 2026 May 15; doi:10.1093/cid/ciag306 |
P: 210 participants with tuberculosis infection (TBI) recruited from 7 tuberculosis clinics in Sydney, Australia (all ages) I: 3 months of weekly isoniazid plus rifapentine (3HP) with SMS adherence reminders C: 4 months of daily rifampicin (4RIF) with standard clinic follow-up O: Treatment completion defined as ≥90% of prescribed doses ingested; adverse events; safety outcomes |
Treatment completion was significantly higher with 3HP compared with 4RIF (84.9% vs 65.4%; RR 1.30, 95% CI 1.22–1.38; P<0.001). Adverse event rates were similar between groups (24.5% vs 20.2%), and no treatment-related deaths occurred. Overall, the weekly 3HP regimen with SMS support improved adherence without increasing safety concerns compared with daily rifampicin. | Moderate risk: Open-label design may introduce performance bias, particularly given differing dosing schedules and SMS adherence support in the intervention arm. Randomisation with site stratification and intention-to-treat analysis strengthen internal validity. Objective primary outcome (dose ingestion ≥90%) reduces detection bias, though self-administered dosing and self-reporting may introduce adherence misclassification. Sample size is relatively small, limiting precision for safety outcomes. |
| Cicuttini FM, Wluka AE, Pan F, O’Sullivan R, Leder K, Cheng AC, et al. Efficacy of antibiotics for chronic low back pain with disc herniation: a randomized clinical trial. JAMA Netw Open. 2026 May;9(5):e2612848. doi:10.1001/jamanetworkopen.2026.12848 |
P: 170 community-based adults aged 18–60 years with chronic low back pain and MRI-confirmed disc herniation (with subgroup analysis including Modic changes) I: Amoxicillin–clavulanate 500 mg/125 mg twice daily for 90 days C: Identical placebo for 90 days O: Pain intensity on Low Back Pain Rating Scale (0–10) at 12 months (primary); pain at 3 months; adverse events |
Amoxicillin–clavulanate did not reduce pain compared with placebo at 12 months (adjusted difference 0.06; 95% CI −0.58 to 0.70) or at 3 months (adjusted difference 0.34; 95% CI −0.18 to 0.86). No benefit was observed in prespecified subgroup analyses including patients with Modic changes. Adverse events were more frequent in the antibiotic group (40.0% vs 23.5%), with one serious adverse event in each group possibly related to treatment. Overall, antibiotics provided no clinical benefit for chronic disc-related low back pain and were associated with higher adverse event rates. | Low risk: Double-blind, placebo-controlled randomized design with allocation concealment and intention-to-treat analysis reduces performance, detection, and selection bias. Adequate follow-up (89.4% at 12 months) limits attrition bias. Telemedicine adaptations due to COVID-19 may introduce minor variability in outcome assessment but primary outcome is patient-reported and standardized. Subgroup analyses increase risk of spurious findings but do not affect primary conclusion. |
| Ornowska M, Wittmann J, Blitz S, Wong H, Vazquez-Grande G, Mitra AR, et al. 4% tetrasodium EDTA to prevent central venous access device–associated complications: a randomized clinical trial. JAMA. 2026 May 18; doi:10.1001/jama.2026.6025 |
P: 1468 adult intensive care unit patients (>18 years) with central venous access devices (CVADs) across 6 Canadian hospitals in a cluster-randomized crossover trial I: 4% tetrasodium EDTA (t-EDTA) locking fluid instilled into unused CVAD lumens C: Saline or 4% citrate locking fluid (standard care, depending on line type) O: Composite CVAD complications including catheter-associated bloodstream infection, catheter occlusion requiring alteplase, and catheter removal due to occlusion |
t-EDTA locking fluid significantly reduced the composite rate of CVAD complications compared with control (13.1 vs 19.9 per 1000 catheter-days; adjusted rate ratio 0.68, 95% CI 0.47–0.96; p=0.03). The reduction was primarily driven by fewer catheter occlusions requiring alteplase (11.67 vs 17.73 per 1000 catheter-days; rate ratio 0.66, 95% CI 0.46–0.96), while bloodstream infection rates did not significantly differ between groups. Overall, t-EDTA improved catheter patency and reduced composite CVAD-related complications. | Low–moderate risk: Strong multicentre cluster-randomized crossover design with triple blinding (patients, clinicians, and outcome assessors) reduces selection and performance bias. Objective outcomes (infection, occlusion, catheter removal) strengthen reliability. However, cluster design may introduce residual confounding and period effects despite crossover. Composite endpoint driven mainly by occlusion rather than infection may overestimate clinical impact on infectious outcomes. Minor risk of implementation variability across ICUs. |
| Rossotti R, Baiguera C, Bernasconi DP, Bana NB, Nava A, Cavazza G, et al. A randomized clinical trial to compare moxifloxacin versus azithromycin for the treatment of Mycoplasma genitalium: the FARTHEST study. Clin Infect Dis. 2026 May 17; doi:10.1093/cid/ciag317 |
P: 358 adults with Mycoplasma genitalium infection detected by multiplex PCR in a monocentric setting I: Moxifloxacin 400 mg once daily for 10 days C: Azithromycin 500 mg once daily for 6 days O: Microbiological cure at ≥28 days after treatment completion (test of cure) in ITT and per-protocol populations |
Moxifloxacin achieved significantly higher microbiological cure rates than azithromycin in the ITT analysis (87.0% vs 61.2%; absolute risk difference 25.8%, 95% CI 16.5–35.2), with superiority confirmed in per-protocol analysis. Moxifloxacin was consistently more effective across most subgroups, while azithromycin showed comparable efficacy only in heterosexual participants. Both regimens were well tolerated with minimal discontinuation. Overall, moxifloxacin demonstrated clear superiority for eradication of M. genitalium infection in the absence of resistance testing. | Moderate risk: Open-label design may introduce performance and adherence bias, although microbiological cure (objective PCR-based outcome) reduces detection bias. Randomization supports internal validity, but monocentric setting limits generalisability. Lack of resistance testing may introduce unmeasured confounding related to baseline resistance patterns. Subgroup analyses increase risk of spurious findings. |
| Mitanchez D, Lacoste-Badie R, Flamant C, Beuchée A, Tourneux P, Mokhtari M, et al. Procalcitonin-guided decision and antibiotic treatment duration in late onset sepsis of newborns: multicentre, randomised controlled trial (ProABIS). BMJ Med. 2026;5(1):e002602. doi:10.1136/bmjmed-2026-002602 |
P: 504 neonates (>24 weeks gestation, >700 g, postnatal age >4 days) with suspected or proven late-onset sepsis requiring antibiotics >48 hours across 33 neonatal units in France I: Procalcitonin-guided antibiotic decision-making with serial PCT monitoring and recommendation to discontinue antibiotics when PCT ≤0.5 µg/L C: Usual care based on local protocols without procalcitonin guidance O: Duration of antibiotic therapy (primary); mortality at day 28; infection recurrence |
Procalcitonin-guided therapy significantly reduced antibiotic duration compared with usual care (median 8 vs 10 days; absolute difference −2.0 days, P<0.001). There was no evidence of harm, with similar 28-day mortality (2.4% vs 3.9%; absolute difference −1.5%, 95% CI −5.0 to 1.8) and similar recurrence rates (2.8% vs 3.9%; absolute difference −1.1%, 95% CI −4.6 to 2.3). Overall, PCT-guided management safely reduced antibiotic exposure in neonatal late-onset sepsis. | Moderate risk: Open-label design may introduce performance bias, particularly in decisions regarding antibiotic discontinuation, although objective mortality and recurrence outcomes reduce detection bias. Multicentre randomised design strengthens external validity. Lack of blinding and reliance on a non-binding recommendation could influence clinician behaviour and adherence to protocol. However, low event rates and consistent safety outcomes support robustness of findings. |
| Quilty BJ, Toizumi M, Nguyen HAT, Le LT, Le HH, Iwasaki C, et al. Sustained and indirect effects of PCV10 reduced-dose schedules on pneumococcal carriage in Viet Nam: a long-term follow-up of a cluster-randomised controlled trial. Lancet Infect Dis. 2026 May 27; doi:10.1016/S1473-3099(26)00172-6 |
P: 49,644 participants from 24 communes in Nha Trang, Viet Nam, including 10,423 infants (4–11 months), 10,988 toddlers (14–24 months), 9,580 preschool children (3–4 years), and 18,653 adult caregivers in a cluster-randomised controlled trial I: Reduced-dose pneumococcal conjugate vaccine schedule 1p+1 (doses at 2 and 12 months) C: Standard-dose PCV10 schedules (2p+1 and 3p+0); additional comparisons with 0p+1 and unvaccinated communes O: Vaccine-type pneumococcal nasopharyngeal carriage prevalence at 5.5 years; indirect effects in unvaccinated age groups; safety outcomes |
The 1p+1 schedule remained non-inferior to standard 2p+1 and 3p+0 schedules for vaccine-type carriage in both infants and toddlers at 5.5 years, with all confidence intervals within the prespecified 5% non-inferiority margin. Vaccine-type carriage declined substantially over time across all groups, including unvaccinated adult caregivers and preschool children, suggesting strong indirect effects regardless of dosing schedule. The lowest carriage proportions were consistently observed across vaccinated groups with minimal between-group differences. No vaccine-related serious adverse events were reported. Overall, reduced-dose schedules maintained long-term effectiveness and population-level protection comparable to standard regimens. | Low–moderate risk: Strong cluster-randomised design with long-term follow-up and large population base enhances external validity. Prespecified non-inferiority framework and clear microbiological outcomes reduce analytic bias. However, cluster-level allocation may introduce residual confounding and ecological effects, and unvaccinated comparison communes may differ systematically. Open-label vaccination status is unavoidable but outcome measurement (nasopharyngeal carriage) is objective. Loss to follow-up and sampling variability across years may introduce some uncertainty in long-term estimates. |
| Wiesenfeld HC, Hong J, Xu T, Cuffe KM, Bernstein KT, Gift TL, et al. A staff-directed electronic medical record alert to increase chlamydia screening: a randomized clinical trial. JAMA Netw Open. 2026 May 29;9(5):e2615360. doi:10.1001/jamanetworkopen.2026.15360 |
P: 18,028 office encounters among women aged 18–24 years (7,356 primary care encounters and 10,672 obstetrics-gynecology encounters) in a cluster-randomized trial across outpatient practices in western Pennsylvania I: Real-time electronic medical record alert directed to medical assistants for women without documented chlamydia screening within the previous year C: Usual care without electronic alert O: Chlamydia screening test orders during office visits |
In primary care practices, chlamydia testing was ordered more frequently in the alert group than in the control group (13.2% [497/3770] vs 3.8% [135/3586]). After adjustment for baseline screening differences, the alert significantly increased the odds of test ordering (AOR 2.74, 95% CI 1.94–3.88). The intervention was effective for both reproductive health–related visits (AOR 2.80, 95% CI 1.70–4.62) and visits for other medical reasons (AOR 2.94, 95% CI 1.78–4.85). No significant effect was observed in obstetrics-gynecology practices. | Moderate risk: The cluster-randomized design strengthens internal validity and reduces contamination between intervention and control practices. However, the intervention was not blinded, creating potential performance bias. The primary outcome (test ordering) was objectively captured through electronic medical records, minimizing detection bias. Baseline differences in screening rates required statistical adjustment, and the pragmatic single-region setting may limit generalizability to other healthcare systems. Attrition bias is likely low because outcomes were obtained from routine electronic records. |
| Dawson R, Diacon AH, Variava E, Moloanto T, Brumskine W, Ngwanto T, et al. Efficacy and safety of a 4-month quabodepistat, delamanid, and bedaquiline regimen for drug-susceptible pulmonary tuberculosis: a multicentre, open-label, randomised, proof-of-concept, non-inferiority, phase 2b/c trial. Lancet Infect Dis. 2026 May 29; doi:10.1016/S1473-3099(26)00143-X |
P: 122 adults aged 18–65 years with newly diagnosed drug-susceptible pulmonary tuberculosis recruited from six sites in South Africa; 121 participants received at least one dose and were included in the modified intention-to-treat analysis I: Four months of delamanid plus bedaquiline plus quabodepistat (DBQ) at one of three dose levels: quabodepistat 10 mg, 30 mg, or 90 mg once daily C: Six months of standard therapy (RHEZ: rifampicin, isoniazid, ethambutol, and pyrazinamide for 8 weeks followed by rifampicin and isoniazid for 18 weeks) O: Primary efficacy outcome: sputum culture conversion by end of treatment; safety and tolerability |
End-of-treatment sputum culture conversion was achieved in 100.0% (20/20) of participants in the DBQ10 group, 92.9% (39/42) in the DBQ30 group, 97.4% (37/38) in the DBQ90 group, 96.0% (96/100) in the pooled DBQ group, and 100.0% (21/21) in the RHEZ group. The pooled DBQ regimen met the prespecified non-inferiority criterion versus standard therapy (difference −4.0%, 80% CI −7.4 to 3.4; non-inferiority margin 12%). Adverse events were predominantly mild to moderate, with no treatment-related serious adverse events or discontinuations. Grade ≥3 adverse events occurred in 20% of DBQ10, 14% of DBQ30, 11% of DBQ90, and 5% of RHEZ participants. One death in the DBQ90 group due to worsening tuberculosis with pneumonia was considered unrelated to treatment. Overall, the 4-month DBQ regimen demonstrated promising efficacy and acceptable tolerability compared with the standard 6-month regimen. | Moderate risk: The randomized design supports internal validity, and microbiology laboratory staff were blinded to treatment allocation, reducing outcome assessment bias. However, the open-label design introduces potential performance and detection bias. The proof-of-concept nature, small sample size (particularly the control arm with only 21 participants), and use of an 80% confidence interval for the non-inferiority analysis limit precision and robustness of conclusions. The primary endpoint was a surrogate microbiological outcome measured at end of treatment rather than long-term relapse-free cure, limiting assessment of durable efficacy. |
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