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This Week in JAMA
June 22/29, 2005

This Week in JAMA

JAMA. 2005;293(24):2967. doi:10.1001/jama.293.24.2967
Combined Tetanus, Diphtheria, and Pertussis Vaccine

Recent cases of pertussis in adolescents and adults have prompted development of new vaccines suitable for this population. Pichichero and colleagues report results of a randomized comparative trial testing the immunogenicity and reactogenicity of a 5-component pertussis vaccine combined with tetanus and diphtheria toxoids (Tdaps) vs licensed tetanus and diphtheria toxoids (Tds) in adolescents and adults. They found that the Tdap vaccine elicited a strong immune response with reactogenicity and safety profiles similar to those of the licensed Td vaccine.

Regional Variations, Temporal Trends in Endocarditis

Regional variations and temporal trends in infective endocarditis (IE) are the subject of 2 articles in this issue of JAMA. First, Fowler and colleaguesArticle report results from a 16-country cohort study of patients with IE. Staphylcoccus aureus was the most common pathogen identified. The majority of these cases were health care associated, but clinical characteristics of patients with S aureus IE varied by region. In a second article based on 1970-2000 population-based data from Olmsted County, Minnesota, Tleyjeh and colleaguesArticle found no change in the annual incidence of IE and that viridans group streptococci were the most common causative organisms during the 3 decades. In an editorial, QuagliarelloArticle discusses the epidemiology of IE and challenges to its prevention.

Treatment of Lower Respiratory Tract Infection

In a randomized trial to assess whether patients with acute lower respiratory tract infection benefit from antibiotics, Little and colleaguesArticle randomly assigned patients to 1 of 6 treatment groups characterized by the offer of immediate, delayed, or no antibiotics and provision (or not) of an informational leaflet. All patients were instructed to keep diaries for symptom duration and severity, which investigators reviewed. They found that compared with patients not offered antibiotics, symptom duration and severity were comparable in the immediate and delayed antibiotic groups. No differential effect was found for patients receiving the informational leaflet compared with those who did not. In an editorial, EbellArticle discusses the natural history of acute bronchitis and the importance of patient-physician communication to reduce antibiotic use in this illness.

Familial Risk of Lung Cancer

Lung cancer is known to aggregate in families, and relatives of patients with lung cancer may wish to know whether they are at increased risk. Coté and colleagues assessed lung cancer aggregation and lifetime risk among parents and siblings of persons with early-onset disease. They found that first-degree relatives of cases had a significantly greater risk of lung cancer compared with population-based controls. Relatives of black cases were at significantly increased risk of lung cancer compared with relatives of white cases, and these risks were further increased for persons who smoked cigarettes.

Medical News & Perspectives

Interim findings from breast cancer clinical trials indicate that giving monoclonal antibodies targeting proteins involved in cancer progression along with chemotherapy can improve progression-free and overall survival compared with chemotherapy alone.

See Article

Opioid Agonists for Neuropathic Pain

In clinical trials assessing the efficacy of opioid agonists vs placebo for relief of neuropathic pain, opioid agonists provided superior relief in trials of intermediate duration (median, 28 days) but not trials of short duration (<24 hours).

See Article

Clinician’s corner

Mycophenolate mofetil may be an alternative to cyclophosphamide for lupus nephritis.

See Article

JAMA Patient Page

For your patients: Information about systemic lupus erythematosus.

See Article