Background: Ingestion of dietary fibers (DFs) is a safe and accessible intervention associated with reductions in blood pressure (BP) and cardiovascular mortality. However, the mechanisms underlying the antihypertensive effects of DFs remain poorly defined. This systematic review and meta-analysis evaluates how DFs influence BP regulation by modulating gut microbial composition and enhancing short-chain fatty acid (SCFA) production. Methods: MEDLINE and EMBASE were systematically searched for interventional studies published between January 2014 and December 2024. Eligible studies assessed the effects of DFs or other prebiotics on systolic BP (SBP) and diastolic BP (DBP) in addition to changes in gut microbial or SCFA composition. Results: Of the 3010 records screened, nineteen studies met the inclusion criteria (seven human, twelve animal). A random-effects meta-analysis was conducted on six human trials reporting post-intervention BP values. Prebiotics were the primary intervention. In hypertensive cohorts, prebiotics significantly reduced SBP (−8.5 mmHg; 95% CI: −13.9, −3.1) and DBP (−5.2 mmHg; 95% CI: −8.5, −2.0). A pooled analysis of hypertensive and non-hypertensive patients showed non-significant reductions in SBP (−4.5 mmHg; 95% CI: −9.3, 0.3) and DBP (−2.5 mmHg; 95% CI: −5.4, 0.4). Animal studies consistently showed BP-lowering effects across diverse etiologies. Prebiotic interventions restored bacterial genera known to metabolize DFs to SCFAs (e.g., Bifidobacteria, Akkermansia, and Coprococcus) and increased SCFA levels. Mechanistically, SCFAs act along gut–organ axes to modulate immune, vascular, and neurohormonal pathways involved in BP regulation. Conclusions: Prebiotic supplementation is a promising strategy to reestablish BP homeostasis in hypertensive patients. Benefits are likely mediated through modulation of the gut microbiota and enhanced SCFA production.

Background: Vancomycin-resistant enterococcus (VRE) infections pose substantial challenges for the treatment and suppression of bone and joint infections. Oritavancin, a long-acting lipoglycopeptide antibiotic, has shown promising in vitro activity against VRE. Limited data are available on using oritavancin for bone and joint infections caused by VRE, both for treatment (therapy to eliminate active infection) and suppressive antimicrobial therapy (long-term antibiotic administration to prevent infection recurrence in patients at high risk for that complication). Questions/purposes: (1) What proportion of patients in a small case series achieve freedom from infectious symptoms with use of oritavancin for treatment of VRE bone and joint infections? (2) What proportion of patients achieve freedom from infection recurrence with use of oritavancin when used for suppressive antimicrobial therapy of VRE bone and joint infections? (3) What proportion of patients develop adverse drug events associated with oritavancin use in VRE bone and joint infections? Methods: We describe a retrospective, multicenter, observational case series of patients who received oritavancin for treatment and/or suppressive antimicrobial therapy of VRE bone and joint infection, including osteomyelitis, native septic arthritis, myositis, and prosthetic joint infection, between December 2014 and April 2024. The minimum surveillance period was 1 year, unless infection recurrence or an adverse drug event was documented before 1 year. Patients were excluded if they had a life expectancy of less than 7 days, dual use of VRE antibiotics, or brain or spinal cord abscesses related to VRE, although no patients met these exclusion criteria in our study group. Clinical signs and symptoms of infection, corresponding microbiological cultures, and adverse drug events were assessed throughout follow-up. Eleven patients (6 treatment, 5 suppressive antimicrobial therapy) with VRE (all Enterococcus faecium) bone and joint infection in which at least one dose of oritavancin was used were included. No patients were excluded because of insufficient follow-up time. In the treatment group, the median (range) age was 60 years (48 to 66), 4 of 6 patients were male, and patients had received prior therapy for VRE with either linezolid or daptomycin. Infections were hardware-associated osteomyelitis in 2 of 6 patients, osteomyelitis in 3 of 6, and prosthetic joint infection in 1 of 6. In the suppressive antimicrobial therapy group, the median (range) age was 61 years (25 to 68), and 3 of 5 patients were female. Four of 5 patients had hardware-associated infections, including 3 of 5 with hardware-associated osteomyelitis and 1 of 5 with prosthetic joint infection of the hip. Results: In the treatment group, 2 of 6 patients remained symptom free at a minimum follow-up of 3 years (range 3.0 to 3.25), and 2 patients developed recurrent infection—one with worsening knee stiffness and growth of VRE and one with radiologic signs of osteomyelitis and growth of methicillin-susceptible Staphylococcus aureus and Candida glabrata. One of 6 patients in the treatment group was lost to follow-up, and one pursued end-of-life care after 28 days. All 5 patients who underwent suppressive antimicrobial therapy remained free from recurrent symptoms with a minimum duration of therapy of 21 months (range 21 to 48). After 48 months of oritavancin as suppressive antimicrobial therapy, one patient in the cohort developed an infusion reaction—shortness of breath, cough, and hypotension—resulting in drug discontinuation. Conclusion: In this small, retrospective cohort of patients with multiple comorbidities, oritavancin showed possible promise as suppressive antimicrobial therapy for VRE bone and joint infection, with all patients receiving suppressive antimicrobial therapy lacking recurrence of infectious symptoms. However, the role of oritavancin as treatment—in salvage situations after multiple therapies failed—appeared more limited in preventing infection recurrence. Larger studies are needed to further define the role of oritavancin in the treatment of VRE bone and joint infections. Level of Evidence: Level IV, therapeutic study.

The purpose of this scoping review was to provide a comprehensive understanding of the current knowledge concerning the gut microbiome and SCFAs as emerging treatments for salt-sensitive hypertension. Relevant animal and human studies were identified via PubMed through August 2024. Twenty-four human (n = 9) and animal (n = 15) trials were included. Most human studies were observational (n = 6), aiming to compare gut microbiota differences between hypertensive and normotensive individuals. Three human studies evaluated microbiome-based interventions either via a sodium-restricted diet (n = 2) or prebiotic supplementation (n = 1). Fifteen animal trials involving either mice or rats were identified, all of which were interventional. These included dietary changes (n = 9), probiotic treatments (n = 1), postbiotic primarily bacterial metabolites (n = 4), and live biotherapeutic products (n = 4). All interventions were effective in decreasing blood pressure. Microbiome-based therapies as biologic modifiers for salt-sensitive hypertension are emerging. Substantial knowledge gaps remain, warranting further research to fully explore this promising therapeutic avenue.

Introduction This study compared the calculated vancomycin area under the curve (AUC_0–24) using trapezoidal and non-trapezoidal first-order pharmacokinetic equations. Methods This retrospective observational study included adult patients with documented MRSA bacteremia who received ≥ 48 h of intravenous vancomycin and had two consecutive serum levels after the first dose. AUC_0–24 was calculated using trapezoidal and non-trapezoidal equations. Correlation and agreement between methods were assessed using Pearson’s correlation coefficient (r) and Bland–Altman plots. Significant predictors (p < 0.05) from simple linear regression were included in a multiple linear regression model to evaluate their impact on AUC_0–24 for both methods. Results Fifty-two patients were included. The median age was 63 years (interquartile range [IQR]: 50–73), and the median vancomycin clearance was 4 l/h (IQR: 2–6). Median vancomycin AUC_0-24 was 399 mg∙h/l (IQR: 257–674) for the trapezoidal method and 572 mg∙h/l (IQR: 466–807) for the non-trapezoidal method. There was a strong correlation between the methods (r = 0.87 [95% CI, 0.79–1]; P < 0.01), but Bland–Altman analysis showed poor agreement, with a bias of – 198 mg∙h/l and 95% limits of agreement from – 482 to 86 mg∙h/l. In multiple linear regression, total daily dose and vancomycin clearance were independent predictors of AUC_0–24 for both methods, with a stronger impact on non-trapezoidal AUC_0-24 (adjusted R² = 0.70) than trapezoidal AUC_0–24 (adjusted R² = 0.59). Conclusions Trapezoidal and non-trapezoidal equations are not interchangeable for estimating vancomycin AUC_0–24. The trapezoidal method consistently results in lower AUC_0–24 estimates than the non-trapezoidal method.

Objective: To review the pharmacology, efficacy, and safety of zoliflodacin for the treatment of uncomplicated urogenital gonorrhea due to Neisseria gonorrhoeae in adults and pediatric patients 12 years of age and older. Data sources and extraction: A literature search was conducted in Scopus, Web of Science, PubMed Central, Gale Academic FileOne, MEDLINE, Journals@Ovid, and Science Direct databases for all articles relevant to zoliflodacin from inception through February 12, 2026. Data synthesis: Preclinical, pharmacokinetic, and clinical trial data have demonstrated that zoliflodacin is effective against multidrug-resistant (MDR) N. gonorrhoeae , with high urogenital cure rates and no current evidence of increasing minimum inhibitory concentrations. Evidence from phase II and III trials supports its single-dose use as an alternative to ceftriaxone; however, the reduced efficacy for pharyngeal and rectal lesions requires additional evaluation. Relevance to patient care and clinical practice in comparison with existing drugs: Zoliflodacin could serve as an oral alternative to ceftriaxone, particularly for patients with a cephalosporin allergy, and be a viable option for resistance-directed therapy. Continued surveillance will be imperative as zoliflodacin use increases. Conclusion: Zoliflodacin is a novel, first-in-class spiropyrimidinetrione antibiotic for the treatment of uncomplicated urogenital gonorrhea that is efficacious and provides a novel option for MDR N. gonorrhoeae.