RESUMEN
The intradermal route has emerged as a dose-sparing alternative during the coronavirus disease 2019 (COVID-19) pandemic. Despite its efficacy in healthy populations, its immunogenicity has not been tested in immune-mediated dermatologic disease (IMDD) patients. This assessor-blinded, randomized-controlled, non-inferiority trial recruited patients with two representative IMDDs (i.e., psoriasis and autoimmune bullous diseases) to vaccinate with fractionated-dose intradermal (fID) or standard intramuscular (sIM) BNT162b2 vaccines as a fourth booster dose under block randomization stratified by age, sex, and their skin diseases. Post-vaccination SARS-CoV-2-specific IgG and interferon-γ responses measured 4 and 12 weeks post-intervention were serological surrogates used for demonstrating treatment effects. Mean differences in log-normalized outcome estimates were calculated with multivariable linear regression adjusting for their baseline values, systemic immunosuppressants used, and prior COVID-19 vaccination history. The non-inferiority margin was set for fID to retain >80% immunogenicity of sIM. With 109 participants included, 53 received fID (all entered an intention-to-treat analysis). The fID demonstrated non-inferiority to sIM in humoral (mean outcome estimates of sIM: 3.3, ΔfID-sIM [mean, 95%CI]: -0.1, -0.3 to 0.0) and cellular (mean outcome estimates of sIM: 3.2, ΔfID-sIM [mean, 95%CI]: 0.1, -0.2 to 0.3) immunogenicity outcomes. Two psoriasis patients from the fID arm (3.8%) developed injection-site Koebner's phenomenon. Fewer fID recipients experienced post-vaccination fever (fID vs. sIM: 1.9% vs. 12.5%, p = 0.027). The overall incidence of disease flare-ups was low without a statistically significant difference between groups. The intradermal BNT162b2 vaccine is a viable booster option for IMDD patients troubled by post-vaccination fever; its role in mitigating the risk of flare-ups remains unclear.
RESUMEN
BACKGROUND: Inappropriate antibiotic use is a major driver of antimicrobial resistance especially in Thailand where people have access to antibiotics without prescription. Consumers may put pressure on clinicians to prescribe antibiotics when they are not necessary, however little is known about Thai patients' expectations. The aim of this study was to explore hospitalised patients' reported behaviours, attitudes and knowledge related to antibiotic use. METHODS: A cross-sectional survey was distributed to patients from selected medical and surgical wards at a 1000-bed university hospital in Bangkok between January and March 2016, Thailand. A total of 205 patients participated. RESULTS: The frequent use of antibiotics in the Thai community, misconceptions about the utility of antibiotics in viral illness, and over the counter acquisition of antibiotics were reported. During hospitalisation, patients were unsure whether they wanted antibiotics but if required, intravenous antibiotics were preferred with 84.0% believing that intravenous antibiotics were stronger. The majority wanted to know more about safe antibiotic use and feared acquiring antimicrobial resistant infections. CONCLUSION: The results of this study add to our understanding of the patient influences on antibiotic use in the Thai setting and can inform strategies for more active patient participation and shared decision-making regarding antibiotic use.