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THE MERCK MANUAL MEDICAL LIBRARY: The Merck Manual of Diagnosis and Therapy
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Merck is committed to bringing out the best in medicine. As part of that effort, Merck has created The Merck Manuals, a series of healthcare books for medical professionals and consumers. As a service to the community, the content of The Manuals is now available in enhanced online versions as part of The Merck Manuals Online Medical Library. The Online Medical Library is updated periodically with new information, and contains photographs, and audio and video material not present in the print versions.

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Editors of The Merck Manual Online

Robert S. Porter, MD, Editor

Justin L. Kaplan, MD, Senior Assistant Editor

Barbara P. Homeier, MD, Assistant Editor

Mark H. Beers, MD, Editor-in-Chief Emeritus

Editorial Board of The Merck Manual Online

Richard K. Albert, MD

Marjorie A. Bowman, MD, MPA

Glenn D. Braunstein, MD

Sidney Cohen, MD

Linda Emanuel, PhD

Jan Fawcett, MD

Eugene P. Frenkel, MD

Susan L. Hendrix, DO

Michael Jacewicz, MD

Brian F. Mandell, MD, PhD

Gerald L. Mandell, MD

Judith S. Palfrey, MD

Albert A. Rundio, Jr., PhD

David A. Spain, MD

Paul H. Tanser, MD, FRCP(C), FRCP (Glasgow)

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Important: The authors, reviewers, and editors of this book have made extensive efforts to ensure that treatments, drugs, and dosage regimens are accurate and conform to the standards accepted at the time of publication. However, constant changes in information resulting from continuing research and clinical experience, reasonable differences in opinions among authorities, unique aspects of individual clinical situations, and the possibility of human error in preparing such an extensive text require that the reader exercise individual judgment when making a clinical decision and, if necessary, consult and compare information from other sources. In particular, the reader is advised to check the product information provided by the manufacturer of a drug product before prescribing or administering it, especially if the drug is unfamiliar or is used infrequently.

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