In this article, a selection of notable peer-reviewed publications from 2025 are provided.
Article Selection by: Bassam Ghanem, Pharm.D., MS, BCPS, BCIDP
Article Construction by: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
As 2025 comes to a close, it has been another remarkable year for infectious diseases research. From groundbreaking vaccine studies to innovative antibiotic strategies and simplified TB regimens, this year has delivered insights that challenge dogma, refine clinical practice, and advance global stewardship efforts.
I’ve selected 20 studies that are practice-changing, paradigm-shifting, or particularly impactful for infectious disease clinicians and antimicrobial stewardship. This summary highlights key findings and takeaways to help busy professionals stay up-to-date with the most relevant developments of the year.
Note: I’m also looking forward to the upcoming podcast in January where leading colleagues will discuss their top papers of 2025 — this list serves as a broader review for clinicians and stewardship teams.
Randomized Controlled Trials & Practice-Shifting Studies
1. Cefazolin vs Cloxacillin for MSSA Bacteremia: Cefazolin Reinforced as MSSA First Choice (CloCeBa | Lancet)
Cefazolin was non-inferior to cloxacillin with fewer adverse events, reinforcing its role as preferred therapy for MSSA bloodstream infections.
2. One-Dose HPV Vaccination: Global Simplification of Prevention (ESCUDDO | NEJM)
One dose of either a bivalent or nonavalent HPV vaccine provided protection against HPV16 or HPV18 infection and was not inferior to two doses.
3. Dalbavancin for Complicated Staphylococcus aureus Bacteremia: Simplifying SAB Therapy (DOTS | JAMA)
Dalbavancin was not superior by DOOR but non-inferior for clinical efficacy at day 70, supporting simplified outpatient management in carefully selected SAB patients.
4. High-Dose Rifampin for Tuberculous Meningitis: Pharmacology Meets Clinical Reality (HARVEST | NEJM)
High-dose oral rifampin failed to reduce 6-month mortality and was associated with earlier deaths and more hepatotoxicity signals, highlighting that pharmacologic plausibility does not guarantee clinical benefit in CNS TB.
5. Oral is the new IV — safer, effective, and evidence-backed (POvIV & COPAT)
POvIV confirmed non-inferiority of oral-only therapy without IV lead-in for fracture-related infections, and COPAT showed that early IV-to-oral transition is safer while maintaining efficacy in serious infections
6. Closing the Chapter on Steroids in CAP: Context Matters (SONIA & REMAP-CAP | NEJM & ICM)
SONIA demonstrated reduced 30-day mortality with steroids in low-resource hospitals, while REMAP-CAP found no 90-day mortality benefit in ICU patients receiving hydrocortisone, highlighting context-specific effects and supporting a nuanced, case-by-case approach.
7. Shorter & All-Oral TB Regimens: Transforming TB Care (TRUNCATE-TB & endTB | Lancet & NEJM)
TRUNCATE-TB confirmed excellent outcomes with 8-week regimens for rifampicin-susceptible TB, and endTB showed shorter all-oral regimens transform MDR-TB management.
8. Mosnodenvir for Dengue: Toward a Dengue Pill (Phase 2 | NEJM)
Mosnodenvir reduced viral load and improved symptoms, representing the first meaningful antiviral advance for dengue infection.
9. Partner Treatment to Reduce BV Recurrence: A Surprising Win (StepUp | NEJM)
Treating male partners significantly reduced bacterial vaginosis recurrence, challenging long-standing management approaches.
10. Doxycycline Post-Exposure Prophylaxis for STIs: Benefits with Caveats (DoxyPEP | Lancet ID)
Doxycycline PEP significantly reduced STI incidence in high-risk populations, though ongoing resistance surveillance remains essential.
11. Oral Antibiotics for Gonorrhea: Gepotidacin & Zoliflodacin Non-Inferior to IV Ceftriaxone (EAGLE-1 & Zoliflodacin Study | Lancet)
Both Gepotidacin and Zoliflodacin were non-inferior for uncomplicated gonorrhea, representing the first new oral agents in decades and offering a new outpatient treatment paradigm.
12. ART Initiation in Late-Presenting HIV: Modern Regimens Perform Equally Well (LAPTOP | Lancet ID)
Both Symtuza and Biktarvy were effective in late presenters, supporting rapid ART initiation without delaying for resistance or disease severity concerns.
13. Methenamine for Recurrent UTI: A Stewardship-Friendly Alternative (ImpresU | CMI)
Methenamine significantly reduced recurrent UTIs in older adults, offering an effective non-antibiotic prophylaxis strategy.
14. Antibiotics Alone for Pediatric Appendicitis: A Shift in Surgical Thinking (APPY | Lancet)
Based on cumulative failure rates and a 20% non-inferiority margin, antibiotic management of non-perforated appendicitis was inferior to appendicectomy.
15. Prophylactic Antibiotics After Perineal Tears: Less Is More (REPAIR | BMJ)
Although no significant effect was seen for overall wound complications, prophylactic antibiotics significantly reduced the risk of clinically relevant wound complications in women with episiotomies and second degree tears and should be considered in postpartum care.
16. Steroids for Severe Pneumocystis Pneumonia in Non-HIV Patients: A Practice-Changer (PIC RCT | Lancet)
In immunocompromised HIV-negative patients with P jirovecii pneumonia, adjunctive corticosteroid treatment did not significantly decrease 28-day mortality.
17. Syndromic PCR for HAP/VAP: Stewardship Gains Without Clinical Non-Inferiority (INHALE | ICM)
In ICU rapid molecular diagnostics improved early antimicrobial targeting and stewardship, though clinical non-inferiority was not demonstrated for cure of pneumonia at 14 days.
18. Individualized Shorter Therapy for Pediatric UTI: Fewer Antibiotics , Slightly More Recurrence (INDI-UTI | Lancet)
Children with febrile UTI assigned to individualised treatment duration had an increased risk of recurrent UTI (by 5·3 percentage points) but reduced antibiotic use and fewer adverse event days within 28 days compared with those assigned to standard 10-day treatment.
19. CRP Point-of-Care Testing in Febrile Children: Diagnostic Stewardship in Action (ARON | Lancet)
In acutely ill children, CRP POCT combined with a decision algorithm reduced antibiotic prescribing without compromising safety, highlighting a scalable stewardship intervention.
20. Early TAF in Chronic Hepatitis B: Shifting the Treatment Paradigm (ATTENTION RCT Interim | Lancet)
Early initiation of tenofovir alafenamide reduced liver-related serious adverse events compared with observation in non-cirrhotic adults with moderate or high HBV viraemia.
Additional Notable Articles, Guidelines & Approvals – 2025
- Review of antibiotic safety in pregnancy — 2025 update
- Navigating the Challenges in Staphylococcus aureus Bloodstream Infection: A Practical Guide to Management
- IDSA: UTI Guidelines
- ATS CAP Guidelines
- ERS Bronchiectasis Guidelines
- ECIL 10 FN Guidelines
New Antimicrobial Approvals – 2025 (Earliest → Latest)
| Date | Drug (Brand / Generic) | Indication | Notes / Relevance |
| Feb 7, 2025 | Emblaveo (aztreonam + avibactam) | Complicated intra‑abdominal infections | First fixed-dose monobactam/β-lactamase inhibitor approved in US |
| Mar 25, 2025 | Blujepa (gepotidacin) | Uncomplicated UTIs (female ≥12y) | First new oral antibiotic class for UTIs in ~30 years |
| Oct 22, 2025 | Contepo (fosfomycin IV) | Complicated urinary tract infections | New IV fosfomycin for cUTI/pyelonephritis |
| Dec 11, 2025 | Blujepa (expanded use) | Uncomplicated gonorrhea | Expanded indication to include gonorrhea |
| Dec 12, 2025 | Nuzolvence (zoliflodacin) | Uncomplicated gonorrhea | First new single‑dose oral gonorrhea antibiotic in decades |
Closing Remarks
2025 has been a year of major advances in infectious diseases, from innovative therapies to refined stewardship strategies. This curated list provides clinicians and stewardship teams with actionable insights to guide patient care, inform practice, and support education initiatives such as podcasts and journal clubs.
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