@NIHRresearch Academic Clinical Lecturer | Paediatric Immunology and Infectious Diseases | Clinical trials | Vaccines | Antibiotics | @apsmunro.bsky.social
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I’ve noticed many comments criticising RCTs of masks or filters come from engineers
These criticisms are often, understandably, caused by misunderstandings about what RCTs are for (engineers do not usually use RCTs)
Here is my attempt to explain
munro-link.alasdairmunro.wor…
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Alasdair Munro retweeted
Does the shingles vaccine reduce the risk of developing dementia? The science isn't as solid as some claim, but private vaccinations are soaring. Was great to speak to @apsmunro to understand where we are at on the evidence:
thetimes.com/article/f9801b5…
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I think this every time I see media criticism that a rare disease has been “missed” in a patient presenting to ED with a common symptom.
Devastating for the individual, but a normal and totally expected outcome of the diagnostic process.W
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Alasdair Munro retweeted
The NHS specifically advises AGAINST sponging or ANY physical cooling measures for fever
It does NOT bring core temperature down, and only serves to make the patient LESS COMFORTABLE by increasing their bodies efforts to keep their temperature elevated
nhs.uk/symptoms/fever-in-chi…
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Excellent to see completely false information (from a doctor, no less) TRENDING on X
Link below with the official information from the NHS - SPECIFICALLY SAYING NOT TO COOL YOUR CHILD WITH A SPONGE
nhs.uk/symptoms/fever-in-chi…
Looks like this post is trending and back on the front page of X! It's an important, educational post that everyone should read.
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Alasdair Munro retweeted
We need this on t-shirts all over the land.
You do absolutely none of these, because physically cooling someone with a fever will make them feel WORSE
Physiologically their hypothalamus already thinks they are cold and is warming them up
Antipyretics can switch this off, but physical cooling is WRONG
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You do absolutely none of these, because physically cooling someone with a fever will make them feel WORSE
Physiologically their hypothalamus already thinks they are cold and is warming them up
Antipyretics can switch this off, but physical cooling is WRONG
At 2 a.m, your partner is burning up with a 103°F (39.4°C) fever. There’s no paracetamol at home. Which cooling method is safest?
A. A cold shower
B. Ice packs on the body
C. Lukewarm-water sponging
D. Alcohol rubbed on the skin
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Two new trials of adjunctive steroids for Kawasaki disease are negative for the primary outcome of reducing coronary artery aneurysms
But I might use them anyway
Why? Join me to explore the conclusive but intriguing results of these new studies!
munro-link.alasdairmunro.wor…
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Alasdair Munro retweeted
The sum total of evidence that IV abx must be used for IE is:
1) uncontrolled case series of oral sulfa drugs (not trim-sulfa, sulfa alone), tetracycline, or erythromycin from the 1940s-50s
2) an opinion from Max Finland in a review article in NEJM in 1954, citing those series
To paraphrase Mr Spock in Star Trek 6, POET is the beginning of wisdom, not the end. Let me lay out the scale of evidence for you supporting the requirement to use iv only abx for endocarditis vs evidence supporting oral abx efficacy…
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Piperacillin/tazobactam (Tazocin, Zosyn etc) is ultimately a drug for Pseudomonas aeruginosa
Are you worried about Pseudomonas? Pip/taz is a great choice
Not worried about Pseudomonas? You don’t need pip/taz, there is almost certainly a better option
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Two new RCTs of adjunctive steroids for Kawasaki disease
Both negative for improving coronary artery aneurysms (primary outcome)
BUT both show quicker resolution of fever and inflammatory markers, and less "salvage therapy" (2nd IVIg, biologics)
Does this make steroids useful?
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A truly insane feature within the NHS is nurses needing specific training to be allowed to give IM vaccines that is completely separate from giving any other IM medication
If a child needs vaccinating on a ward, frequently a paediatric SHO will need to give it
Non-sensical
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A call to abandon performative physical examinations. Join me?
Physical Examination for Asymptomatic Adults | New England Journal of Medicine nejm.org/doi/full/10.1056/NE…
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Alasdair Munro retweeted
Kids are back to school, which means the onslaught of recurrent coughs and colds is about to begin!
But is there any way of “boosting”kids immunity with diet/supplements or exercise to stop them getting sick?
We reviewed the evidence to find out 🧐
munro-link.alasdairmunro.wor…
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Can I boost my child’s immunity with diet or supplements? The short answer is No
alasdairmunro.substack.com/p… via @apsmunro
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Alasdair Munro retweeted
Interesting post about TriNetX. This is the source for the recent shingles/heart failure piece. It is a very odd database..
Multiple independent analyses by researchers ensures the integrity of results.
While journals require that the authors "have access to the data" authors often use data analyzed by others and not themselves.
"Editors and reviewers need to decide whether authors should be permitted to outsource important analytic decisions."
retractionwatch.com/2026/08/…
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The looks on people’s faces every time I prescribe doxycycline for a child 🤭
ITS 2026 PEOPLE GET WITH THE TIMES
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Alasdair Munro retweeted
Best, and most unexpected, acknowledgements section of a covid paper
#dolly
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I am on a crusade to stop hospital specialists using IV antibiotics where oral antibiotics can be used instead
They are cheaper, safer and more convenient for the patient and the nursing staff
If you want to use the worse alternative you must provide a convincing reason why
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