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6 May 2003 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

For Early Lyme Disease, 10 Days of Antibiotics Are as Effective as 20 Days

In a study of 180 people diagnosed with early, uncomplicated Lyme disease, a ten-day course of the antibiotic doxycycline was as effective as a 20-day course (Article, p. 697). Physicians generally prescribe between 10 and 21 days of the antibiotic for early Lyme disease. This randomized trial evaluated neurological, cardiac, and joint disease outcomes several times over a 2.5 year period after the completion of treatment. Approximately two-thirds of patients in all groups had no evidence of Lyme disease at 20 days, and more than 80 percent of all patients had a complete response to treatment at 30 months. An editorial writer concludes that 10 days of therapy are usually sufficient for people with early, uncomplicated Lyme disease (Editorial, p. 761). (This article is the subject of a video news release. Call for coordinates.)

Study Finds That Many People Can't Accurately Recall if They or Family Members Had 2 Skin Diseases That Contraindicate Smallpox Vaccination

(Early release article online only.)

Current guidelines from the Centers for Disease Control recommend that people with the skin conditions atopic dermatitis or eczema and their household contacts should not receive the smallpox vaccine. A new study showed that 419 of 54,000 people in a large health system (about 0.8 percent) had one of these two skin conditions in 2000 or 2001. In a telephone survey of people who had been diagnosed with atopic dermatitis in 1979 and members of their household, 40 percent did not correctly report that they or a household member had atopic dermatitis or eczema. The authors conclude that patients frequently fail to report a history of atopic dermatitis or eczema, skin conditions that put them at high risk of serious complications of smallpox vaccination. Similarly, household members frequently fail to report that another family member has had atopic dermatitis or eczema. Failure to report these conditions could increase the risk of widespread vaccination against smallpox. (This article will be available online at 5 p.m. EDT, Monday, May 5. It will appear in July 1, 2003, print edition of Annals.)

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