The combination with corticosteroids as immunomodulators has been the subject of debate in different infectious syndromes. The main objective of this study is to evaluate the efficacy (the percentage of patients hospitalised with influenza with a status of 3 or higher according to the Hospital Recovery Scale (HRS) on day 7 after the start of treatment) and safety of dexamethasone.

Investigator-initiated multicentre, blinded, randomised placebo-controlled trial with two parallel treatment arms. The study population will consist of adult patients (over 18 years of age) hospitalised with severe influenza. One arm will receive one capsule of 6 mg of dexamethasone for 7 days, and the other arm will receive one capsule of placebo for 7 days of antibiotic treatment for 7 days or longer. Both groups will receive oseltamivir (75 mg/12 hours orally) for 5 days, extendable to 10 days depending on the investigator decision. Randomisation will occur in equal proportion (1:1). Patients with bronchial hyper-responsiveness that requires systemic corticosteroids for more than 24 hours, preinclusion treatment with corticosteroids for more than 24 hours at a dose equal to or higher than 1 mg/kg methylprednisolone (0.2 mg/kg dexamethasone or 1.25 mg/kg prednisone), inability to administer oral oseltamivir, patients with severe comorbidity with a life expectancy of

The study is approved by the Institutional Review Board of Alicante Health Department—Dr. Balmis General University Hospital (LOC-100061146). The results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal

NCT06528444.

Women with recurrent urinary tract infections (UTIs) often undergo intensive antibiotic exposure, especially with suppressive therapies. Suppressive therapy is recommended for women with three UTIs in the past year or two in the last 6 months. However, the collateral long-term effects of this have been poorly studied.

To assess whether suppressive therapy for recurrent UTIs increases the incidence and severity of future infections compared with episodic UTI treatment.

Retrospective cohort study.

The study was conducted using data from the Information System for Research in Primary Care database, including 5.8 million people in Catalonia. Two groups of women with recurrent UTIs (≥3 episodes/year) were compared: those on suppressive antibiotic therapy for ≥6 months and those treated episodically. Primary outcomes were hospitalisations due to pyelonephritis, septicaemia, COVID-19, influenza, pneumonia and mortality by these infections, over a 100-month follow-up period.

Among 36 170 women, 2898 (8%) were treated with continuous suppressive therapy. Overall, 6.9% of the population experienced severe infections, with a higher incidence in women on suppressive therapy (12.6%) compared with those without (6.4%), with a HR of 1.50 (95% CI 1.33 to 1.68). Pyelonephritis presented the greatest difference (HR, 1.95 (95% CI 1.64 to 2.33)), followed by septicaemia (HR, 1.34 (95% CI 1.13 to 1.59)) and COVID-19 (HR 1.23 (95% CI 1.01 to 1.50)).

Suppressive antibiotic therapy in women with recurrent UTIs is associated with a higher incidence and severity of future infections. Future research should focus on clarifying causal relationships and identifying the potential mechanisms involved.