John Howie, Pharmacist, Orange, NSW

The busy practitioner who needs an Australian reference for drugs available in this country does not want one which weighs several kilos or runs to two volumes - not as a first resort at any rate. The Australian Medicines Handbook, first published in 1998, is light and compact in size, yet comprehensive in content. Unlike other current texts the information is easy to read: the print is not too small or congested and is set in two columns (each 60 mm) to a page with bold black headings and blue sub-headings.

Each chapter represents an organ system or a broad therapeutic drug class within which drugs are grouped according to their indicated use and then introduced with information on rationale for use and considerations to be made before starting treatment. The action of each group is explained simply and clearly and indications and contraindications given. Special considerations such as coexisting medical conditions are dealt with and adverse effects listed according to whether they are common, infrequent or rare.

This latest edition includes new therapeutic topics covering acute coronary syndromes and androgenic alopecia. There is expanded information about vaccines as well as new evidence in many therapeutic areas, notably hormone replacement therapy, and the treatment and prevention of thromboembolism.

Perhaps the most useful information is to be found under the headings 'Comparative information' and 'Practice points'. The first of these will greatly assist the prescriber or reviewing pharmacist to decide which is the most appropriate drug within a class and this information is frequently set out in table form making it readily accessible. The second lists important points to be aware of when a drug is used (for example under Nitrates: 'tolerance to nitrates occurs with frequent or continuous exposure (may occur within 24 hours); avoid by ensuring a nitrate-free interval of 10-12 hours each day') and advice and information to give patients, an important consideration if medications are to be used effectively.

What I like most about this book is its clarity and brevity and the way important information is presented. It is impossible for example to miss the warning boxes inserted to emphasise a serious adverse effect. I cannot imagine anyone who is in need of a concise, accurate and up-to-date drug reference not wanting this volume as a primary reference and at $152 it is well worth the investment.

Merilyn Liddell, Professor and Head, Department of General Practice, Monash University, Melbourne

On first impression, the Australian Medicines Handbook (AMH) is attractive to look at and feel, and is small enough to keep easily to hand. I found the setting out good, although the soft mauve of the sub-headings is a little difficult to read, making it more difficult to find the section you are looking for. It is useful to have the numbers for the Poisons Information Centre and the Australian Sports Drug Agency inside the front cover in a prominent position.

The CD version is very easy to use, with an intuitive interface. It has menus which drop down at the point of the mouse, and an excellent search facility, with hot links. I had not used the CD version before, and found it better than expected. I would be interested to know if a PDA version is to be developed.*

The AMH maintains the very user-friendly general structure of the previous editions. It has 20 main chapters, based on body systems or a general therapeutic type. In each of these chapters it provides information about each particular class of drug (and some mention generally if there is or is not significant intraclass difference), followed by information about specific drugs in the class.

The great benefit of the AMH is its authoritative evidence-based content, independent of commercial interest. This is particularly important when needing information to choose between different drugs. Classic textbooks often stop at the class level, but the AMH includes authoritative discussion of intraclass difference. The amount of detail is well controlled - all the information is useful at a practical level, and the format allows quick scanning if just needing a specific piece of information. It is much easier to digest than formal product information material, and the content incorporates a wider range of evidence than included in product information.

Information on prescribing for particular groups is helpful, notably in pregnancy and lactation, children, the elderly, and in hepatic and renal insufficiency.

A couple of details that may be worth including in the future would be:

  • information on sporting restrictions for particular drugs
  • interactions between drugs and foods
  • a full table of contents at the beginning of the hard copy.

These minor limitations however do not detract from it as being overall an excellent comprehensive and user-friendly text.

The AMH is in my view one of the absolutely key requirements for modern practice, especially for the general practitioner. It should have the same status as the stethoscope and the sphygmomanometer on the doctor's desk.

* Editor's note: A PDA version is planned.

John Howie

Pharmacist, Orange, NSW