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This In the Literature piece details a study evaluating the appropriateness of prescriptions in comparison to evidence-based guidelines and expert opinion.

Appropriate or Not? A Look at Antibiotic Use in the Emergency Department

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

U.S. FDA Approves Merck’s ENFLONSIA™ (clesrovimab-cfor) for Prevention of Respiratory Syncytial Virus (RSV) Lower Respiratory Tract Disease in Infants Born During or Entering Their First RSV Season

The US Food and Drug Administration (FDA) has approved Merck’s clesrovimab (MK-1654), a long-acting monoclonal antibody designed to provide passive immunization against respiratory syncytial virus (RSV) for infants during their first RSV season. This single-dose, weight-independent treatment demonstrated strong efficacy in pivotal Phase 2b/3 trials,reducing medically attended RSV lower respiratory infections by 60.5% and RSV-related hospitalizations by 84.3% compared to placebo. Merck plans to make clesrovimab available for the 2025-26 RSV season, expanding preventative options beyond currently approved therapies.

“We’re very proud that the FDA has approved clesrovimab, which is now called enflonsia, for the prevention of RSV for newborns entering their first RSV season,” said Macaya Douoguih, MD, MPH, therapeutic area head for global vaccine clinical development at Merck. “We do plan to make enflonsia available for ordering in July with shipments that will be delivered before the start of the upcoming season later this fall.”

RSV remains a leading cause of hospitalization and death in infants worldwide, highlighting the critical need for effective prevention. Enflonsia’s approval positions Merck alongside Sanofi and AstraZeneca’s Beyfortus, the first FDA-approved long-acting RSV antibody, which has shown 90% effectiveness against RSV hospitalizations.

“Monoclonal antibodies have a very important role to play in terms of addressing the significant burden of RSV, which still remains the leading cause of hospitalization in infants in the US today,” Douoguih added. “It also affirms that demonstrating safety and efficacy through rigorous randomized placebo or active control trials is essential for approval.”

FDA Accepts Merck’s Biologics License Application for Infant RSV Protection

On December 17, 2024, the FDA accepted Merck’s Biologics License Application (BLA) for enflonsia (MK-1654), a long-acting monoclonal antibody designed to protect infants from RSV during their first RSV season.

The BLA was supported by data from the Phase 2b/3 CLEVER trial, a randomized placebo-controlled study evaluating a single dose of enflonsia in healthy preterm and full-term infants (birth to 1 year). The trial demonstrated a 60.5% reduction in medically attended RSV lower respiratory infections (MALRI) and an 84.3% reduction in RSV-related hospitalizations through Day 150, regardless of infant weight. Interim data from the ongoing Phase 3 SMART trial, comparing enflonsia to palivizumab in infants at increased risk for severe RSV disease, further support the safety and efficacy of enflonsia.

“The approval was based on results from our Phase 2b/3 trial called CLEVER, which evaluated a single dose of enflonsia administered to preterm and full-term infants from birth up to age one, and the trial met its key primary and secondary endpoints,” said Douoguih. “We showed an efficacy of 60.5%, and importantly, we also demonstrated protection against hospitalization—84.3%. Hospitalization is one of the most important outcomes that worry not only clinicians but also the parents.”

Merck’s Long-Acting RSV Antibody Shows High Efficacy in Infant Prevention Studies

, infectious disease physician and product development lead at Merck, presented results from the Phase 2b/3 CLEVER trial, which enrolled 3,614 healthy preterm and full-term infants. The double-blind, placebo-controlled study showed enflonsia reduced medically attended lower respiratory infections by 60.5%, RSV-related hospitalizations by 84.3%, and hospitalizations due to RSV-associated lower respiratory infections by 90.9% over 150 days. Additionally, severe cases of MALRI declined by 91.7%. Safety data indicated a comparable profile to placebo, with no treatment-related deaths.

“What our data show is that we see increasing efficacy with increasing disease severity—and that’s a very important finding,” Douoguih noted. “Our monoclonal combines the convenience of dosing with the strong clinical data showing significant reductions in RSV disease and hospitalizations. It’s really a new, promising preventive option for our large US population.”

Interim findings from the ongoing Phase 3 SMART trial, which compares enflonsia with the current standard of care, palivizumab, in high-risk infants, including those with chronic lung or congenital heart disease, showed comparable safety and efficacy, supporting clesrovimab’s use across both healthy and high-risk infant populations.

“Our approval is also supported by the results from another trial that we did, a Phase 3 trial called SMART, where we evaluated the safety and effectiveness of enflonsia versus palivizumab,” Douoguih explained. “Those two trials were pivotal in supporting the approval.”

1. US FDA Approves Merck’s ENFLONSIA™ (clesrovimab-cfor) for Prevention of Respiratory Syncytial Virus (RSV) Lower Respiratory Tract Disease in Infants Born During or Entering Their First RSV Season. Merck. Press release. June 9, 2025. Accessed June 9, 2025. https://www.merck.com/news/u-s-fda-approves-mercks-enflonsia-clesrovimab-cfor-for-prevention-of-respiratory-syncytial-virus-rsv-lower-respiratory-tract-disease-in-infants-born-during-or-entering-their-fir/

2. Merck Announces FDA Acceptance of Biologics License Application for Clesrovimab, an Investigational Long-Acting Monoclonal Antibody Designed to Protect Infants from RSV Disease During their First RSV Season. Merck press release. December 17, 2024. Accessed June 9, 2025. 

https://www.merck.com/news/merck-announces-fda-acceptance-of-biologics-license-application-for-clesrovimab-an-investigational-long-acting-monoclonal-antibody-designed-to-protect-infants-from-rsv-disease-during-their-first-rsv/

3. Merck’s Clesrovimab (MK-1654), an Investigational Respiratory Syncytial Virus (RSV) Preventative Monoclonal Antibody, Significantly Reduced Incidence of RSV Disease and Hospitalization in Healthy Preterm and Full-term Infants. Merck. October 17, 2024. Accessed June 9, 2025. 

https://www.businesswire.com/news/home/20241017875997/en

4. A Phase 2b/3 Study to Evaluate the Efficacy and Safety of an Investigational Respiratory Syncytial Virus (RSV) Antibody, Clesrovimab, in Healthy Preterm and Full-Term Infants. Presentation #166 presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.

5. Phase 3, Randomized, Controlled Trial Evaluating Safety, Efficacy, and Pharmacokinetics (PK) of Clesrovimab in Infants and Children at Increased Risk for Severe Respiratory Syncytial Virus (RSV) Disease. Presentation #167 presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.

Enflonsia, a single-dose, long-acting antibody, has been FDA approved to significantly reduce RSV infections and hospitalizations in infants, providing new hope for protecting vulnerable babies during RSV season.


Merck’s Clesrovimab (Enflonsia) Receives FDA Approval to Protect Infants From RSV During First Season

Health and Human Services (HHS) Secretary Robert F Kennedy Jr has appointed eight new members to the CDC’s Advisory Committee on Immunization Practices (ACIP), just two days after removing all 17 previous members. The newly named appointees have drawn scrutiny for affiliations with vaccine-skeptical movements and controversial views on public health.¹

Kennedy announced the appointments via a social media post on X.¹

Among the appointees, Malone has promoted unproven COVID-19 treatments such as hydroxychloroquine and ivermectin and has questioned the safety of COVID-19 vaccines. He has also claimed—contrary to expert consensus and peer-reviewed literature—that he played a central role in inventing mRNA vaccine technology.¹

Another appointee, Pebsworth, has served on the board of the National Vaccine Information Center (NVIC), a group widely criticized for spreading vaccine misinformation. A 2021 study by the University of Connecticut found that groups like NVIC often use emotional rhetoric to foster distrust in vaccines.¹

Kulldorff and Meissner were signatories to the 2020 Great Barrington Declaration, which opposed pandemic mitigation strategies such as masking and lockdowns. The declaration advocated for herd immunity through natural infection, a view widely rejected by public health agencies during the COVID-19 pandemic.¹

The American Medical Association (AMA) has adopted an emergency resolution urging a Senate investigation into HHS Secretary (RFK) Jr’s decision to dismiss all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP). The action occurred less than 24 hours after Kennedy announced the removals.

The resolution, passed during the AMA’s annual meeting, calls on the Senate Health, Education, Labor, and Pensions (HELP) Committee to probe the firings. It also urges Secretary Kennedy to reverse the decision and reaffirms AMA support for evidence-based, independent vaccine advisory bodies.

Despite debate over the potential political consequences, the resolution passed by voice vote. Delegates from major physician groups, including the American College of Physicians, American Academy of Pediatrics, and others, co-authored the measure. Jason Goldman, MD, the ACP’s liaison to ACIP, introduced the resolution, citing assurances from HELP Chair Sen. Bill Cassidy, MD (R-La), that ACIP would remain intact.

The dismissals followed a June 9 HHS announcement confirming a full reconstitution of ACIP. RFK defended the move as necessary to rebuild public trust and reduce perceived conflicts of interest. He emphasized that the prior committee’s composition, with 13 members appointed in 2024, could have locked in previous policies until 2028.

ACIP, which advises the CDC on vaccine policy, has been a key source of independent, evidence-based recommendations. RFK has criticized its past operation and announced that new members will be installed ahead of the upcoming meeting scheduled for June 25–27, 2025.

Public health leaders, including AMA President Bruce A Scott, MD, and APHA Executive Director Georges Benjamin, MD, voiced concern about the move’s impact on trust and vaccine policy. The CDC has since removed the public listing of the ACIP members from its website.

References
1. Eaton ES. RFK Jr.'s new ACIP appointees include several with ties to vaccine misinformation. June 12, 2025. Accessed June 12, 2025. 

https://firstwordpharma.com/story/5972247

2. U.S. Department of Health and Human Services. HHS Takes Bold Step to Restore Public Trust in Vaccines by Reconstituting ACIP. Press release. June 9, 2025. Accessed June 12, 2025. https://www.hhs.gov/press-room/hhs-restore-public-trust-vaccines-acip.html

3. Ungar L, Seitz A. RFK Jr. ousts entire CDC vaccine advisory committee. Associated Press. Published June 9, 2025. Accessed June 12, 2025. https://apnews.com/article/kennedy-cdc-acip-vaccines-3790c89f45b6314c5c7b686db0e3a8f9

The replacement of all 17 ACIP members sparks concern among medical experts and prompts calls for Senate investigation.

HHS Secretary RFK Jr Replaces CDC Vaccine Advisory Panel With New Appointees

At MADID 2025, William R. Mikesell presented data Showing 20% vs. 16% treatment failure rates in doxycycline and minocycline groups.

A multi-hospital retrospective cohort study conducted across Indiana University Health (IU Health) hospitals has found no significant differences in treatment outcomes between doxycycline and minocycline for managing bone and joint infections. The study, presented at MADID 2025, by William R. Mikesell, PharmD, PGY2 infectious diseases pharmacy resident at Indiana University Health, builds on the foundation laid by the OVIVA trial, which established oral antibiotics as a noninferior alternative to intravenous therapy for these infections.

The study included adult patients treated between January 1, 2016, and August 1, 2024, who received either doxycycline (n=41) or minocycline (n=38) for a minimum of two weeks of a planned six-week antibiotic course. Patients receiving additional antibiotics for unrelated infections, as well as pregnant or incarcerated patients, were excluded.

The primary endpoint was treatment failure, defined as any of the following: emergency department visit or hospital readmission for bone or joint infection, antibiotic change due to resistance, presence of a draining sinus tract or frank purulence near the bone or prosthesis, positive repeat tissue culture, or biopsy evidence of infection. Secondary outcomes included adverse effects, need for extended therapy, and early discontinuation of treatment.

Treatment failure occurred in 20% of doxycycline-treated patients and 16% of those treated with minocycline, a difference that was not statistically significant. The most common infection sites included the foot, followed by the leg, knee, hand, arm, hip, and pelvis. Staphylococcus aureus—both methicillin-resistant (MRSA) and methicillin-susceptible strains—and coagulase-negative Staphylococcus species were the predominant pathogens. Secondary outcomes such as adverse event rates, additional antibiotic duration, and early therapy discontinuation were also similar across both groups.

William R. Mikesell explained the motivation behind the study, stating, “The study originally came up because our providers at University Hospital—which treats more immunocompromised patients—prefer to use minocycline for their bone and joint infections. This is in contrast to Methodist Hospital, where they preferred doxycycline.” He added, “Some of the providers at University wanted us to look into this because they believe minocycline is a better treatment option over doxycycline. There’s research out there suggesting that doxycycline induces its own resistance in MRSA isolates—specifically if they have the TetM ribosomal protection proteins. So, they elected to use minocycline over doxycycline.”

When asked if any patient subgroups or infection sites showed a preference for one antibiotic, Mikesell said, “Overall, the research showed there was no statistical difference between the two groups. Minocycline did have less treatment failure, which we defined similarly to the AVIVA trial. That included things like if they were readmitted, if they had frank pus, repeat bacteria isolates from the sample, or any radiologic findings showing that the infection was still present.” He noted, “There wasn’t a statistically significant difference. However, there were more MRSA isolates in the minocycline group. So, I think if there were more patients in the study—and if the study was conducted over a longer period of time—there could potentially be a difference.”

Addressing future directions, Mikesell emphasized the need for prospective studies: “Well, our study was retrospective in nature. Being a resident, there’s only so much time you have. Also, our study only included a 90-day follow-up. The AVIVA trial did a full year of follow-up. I think if there were more prospective trials looking at PO antibiotic options for bone and joint infections—designed similarly to the AVIVA trial—that would be perfect.”

These findings suggest comparable clinical effectiveness between doxycycline and minocycline as oral step-down therapies for bone and joint infections, reinforcing the flexibility clinicians have when tailoring treatment. However, larger, prospective trials are needed to validate these retrospective findings and to further explore resistance patterns and optimal antibiotic selection in diverse patient populations.

Mikesell W, Wrin J. Doxycycline vs. minocycline for the treatment of bone and joint infections. Abstract 94 OR FRS. MAD-ID Meeting. May 28–31, 2025. Orlando, FL.

At MAD-ID 2025, William R Mikesell, PharmD, presented data showing 20% vs 16% treatment failure rates in doxycycline and minocycline groups.

Conferences

No Significant Difference Between Doxycycline and Minocycline for Bone and Joint Infections

Andrew Handel, MD, discusses prevention, how to remove ticks, and the burden of Lyme disease in certain populations. 

‘Tis the Season: Addressing Tick-Borne Illnesses

With the warm weather brings the return of people being outside and the possibility of contracting tick-borne diseases. According to the Centers for Disease Control and Prevention (CDC), more than 89,000 cases of Lyme disease were reported in 2023 by state health departments and the District of Columbia. However, these numbers come from routine national surveillance and may underrepresent the actual burden. 

CDC also estimates that approximately 476,000 people in the US are diagnosed with Lyme disease each year using other data collection methods. This number likely includes patients who are treated based on clinical suspicion but do not actually have Lyme disease, according to the federal agency.

 provides critical insights into the emergence of babesiosis—another tick-borne illness—in the Mid-Atlantic region. Babesiosis can be more severe than Lyme disease, and can become a life-threatening disease for the elderly. 

With this possibility, it is important for clinicians and the general public to consider tick-safety when outside in areas where they live.

“Ticks tend to live on tall grasses and brush in forested areas, so if you go out and you hiking and you know you're going to be in exposed areas where ticks like to live, you want to make sure to stay in the middle of that path, far away from the sides where the ticks are hanging out on the tall grass waiting to grab onto you,” Andrew Handel, MD, said. 

Handel is a pediatric infectious diseases physician at Stony Brook Children's Hospital and at Stony Brook’s Regional Tick-Borne Disease Center in Hampton Bays, NY

 which is the first and only dedicated tick clinic in the Northeast. The center offers tick removal, diagnosis, and treatment. It can test for tick-borne illnesses as well as counsel patients on tick bite prevention and tick identification.

Handel explains that along with trying to stay clear of areas where the ticks live, there are several other strategies to stay tick-free. These include:

Wear light-colored, long-sleeve shirts and pants to make ticks more identifiable.

Tuck your pants into your socks so the ticks don't have access to your skin

Perform routine tick checks when coming from the outdoors or nightly tick checks

Check unexpected and common places on your body for ticks. Ticks love to hide in the beltline, behind the ears, hairline, and in skin folds

If outdoors for an extensive time, consider treating clothes with permethrin, which kills ticks on contact

Put your clothes in the dryer for 10 minutes on high heat to kill any ticks

Handel says it is important to check for ticks after being out in nature, and for those who live in endemic areas such as the northeastern part of the US. In these latter areas it is a good habit to get into even when just out in the yard. He offers some guidance on checking for them.

“You want to really inspect all of your skin, head to toe, looking for any small ticks—many of them look like just the size of poppy seeds. Areas that are really important to check are behind the ears, along the beltline, and in skin folds,” Handel said. “Ticks really like to get into the skin folds, so whether that's in the armpit or the groin, and hide there, making it difficult to find them. And any areas that have hair you want to search really well there too, because again, the ticks have a way of getting underneath the hair and making it really difficult to find. So if you're not thorough, you might miss one.”

In terms of pulling ticks off, Handel says there is a very specific method.

“With your tweezers, you're going to grab them as close to the skin as possible, right at the head of the tick, where it's biting, and just firmly pull it upward. You don't want to twist it. You don't want to grab the belly and squeeze it. That can actually make it more likely that you end up with a tick-borne infection,” Handel said. “So you're going to take the tick, remove it very gently with the tweezers and put it in a sterile container, or a sealed container." He says by holding onto the tick it can be identified, which can be understood if it is a potential carrier of Lyme disease, for example. 

He also cautions people not to try other methods such as burning the tick off or putting petroleum jelly or an ointment on the spot where the tick is. He says this could also lead to tick-borne infections.

Lyme disease has a tendency to be in 2 populations: children of a certain age and seniors. “The first is in children, when they're around 5 to 9 years old. And then a second peak happens in older adults, generally starting around 60 years or older,” Handel said. “There's not definitive proof as to why it happens, but it seems to be exposure to the ticks.”



Stony Book has a free tick-borne disease helpline. For people interested in using it, they can call (631) 726-TICK (8425).


References
1. Lyme Disease Surveillance and Data. CDC. March 13, 2025. Accessed June 6, 2025. https://www.cdc.gov/lyme/data-research/facts-stats/index.html
2. Stromdahl EY, Feldman KA, Nadolny RM, et al. Emerging babesiosis in the mid-Atlantic: autochthonous human babesiosis cases and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) and Ixodes keiransi (Acari: Ixodidae) ticks from Delaware, Maryland, Virginia, West Virginia, and the District of Columbia, 2009 to 2024. 

. Published online April 22, 2025. doi:10.1093/jme/tjaf054

'Tis the Season: Addressing Tick-Borne Illnesses

Fungal infections present a significant global health threat due to rising antifungal resistance, yet few new antifungal drugs are in clinical development. This study evaluated five phytocannabinoids for antifungal activity against key fungal pathogens, focusing on the priority pathogen 

. Cannabidiol (CBD) and Cannabidivarin (CBDV) demonstrated broad fungicidal activity against 

 and other fungi, including dermatophytes causing common tinea infections. 

Both compounds inhibited biofilm formation and reduced virulence factors such as capsule size. Proteomic analyses indicated that CBD and CBDV disrupt fungal cell membranes, alter ergosterol biosynthesis, affect metabolic pathways, and selectively target mitochondrial proteins. In vivo testing using a 

 showed significantly improved survival following topical CBD treatment. These findings highlight phytocannabinoids, particularly CBD and CBDV, as promising candidates for novel antifungal therapies.

We recently conducted an email interview with associate professor Amy K Cain, ARC future fellow at the School of Natural Sciences, Macquarie University, to discuss her team’s promising research on the antifungal properties of phytocannabinoids, particularly CBD and CBDV, and their potential to address drug-resistant fungal infections such as 

Contagion: How do the antifungal effects of CBD and CBDV compare with existing standard antifungal treatments in terms of efficacy and safety?

Cain: Our study shows promising results compared to existing antifungals. For instance, phytocannabinoids demonstrated quicker antifungal effects against 

 than amphotericin B, a standard antifungal; most fungal cells were killed within 1 hour with CBD or CBDV, whereas amphotericin B requires around 4 hours to achieve similar effects. Additionally, CBD is already used clinically for conditions like epilepsy and pain management, and these uses have established an excellent safety profile, even with oral administration.

Contagion: Given that CBD and CBDV showed activity against biofilms and virulence factors in 

, what are the implications for treating difficult fungal infections, especially those resistant to current antifungal drugs?

Cain: We believe phytocannabinoids have strong potential for treating challenging fungal infections. Our data demonstrate their broad antifungal activity across multiple clinical strains of

, and we are currently investigating their effects on drug-resistant strains, which look promising so far.

Contagion: What are the next steps to translate these findings, especially the promising in vivo results in the Galleria mellonella model, into clinical trials or human treatments for fungal infections?

Q&A with Amy Cain discusses cannabidiol and cannabidivarin’s effects on fungal biofilms and drug-resistant strains.

Molly Hayes, PharmD, BCPS

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