Picaridin (KBR 3023), which has been used as an insect repellent for years in Europe and Australia (Autan Repel, and others), is now available in the US in 7% solution as Cutter Advanced (Spectrum Brands). The US Centers for Disease Control and Prevention (CDC) is recommending it as an alternative to DEET.

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Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers for Disease Control (CDC) at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel. Recommendations for the treatment of parasitic diseases are available in the public reading room of The Medical Letter's web site.

Insect repellents have been used on the skin for many years, primarily to prevent mosquito bites, which transmit malaria, West Nile virus infection, and various types of encephalitis. With increased concern about Lyme disease in recent years, skin and clothing repellents are now also recommended for protection against ticks. This review describes the effectiveness of the most widely used repellents DEET and permethrin , as well as some alternatives, and a new product called picaridin that may be available soon. The safety of these products is also discussed. The review concludes with an overall assessment of safety and efficacy and a recommendation on how to achieve the best protection.