David Brookman, Discipline of General Practice, University of Newcastle, NSW
How can one review a book which has become such a common sight in general practitioners' surgeries, hospitals, and everywhere prescriptions are written, and which was the first in a wave of therapeutic guidelines in Australia?
This book has been used for the selection of antibiotics in several circumstances:
- where the practitioner has a limited knowledge of the infection they are treating
- where the comorbidity of the patient makes antibiotic selection more complex
- where there is unknown life-threatening sepsis
- where there have been previous adverse reactions to antibiotics which are the first or second choice
- in different physiological states - pregnancy, renal impairment, childhood.
The main section of the book is a set of headings of infections and infestations of all body systems with recommended first- and second-line therapy. For practitioners seeking third-line medications for a likely or known organism where there is a history of adverse reaction to the first- or second-line drugs, it is necessary to consult Table 49 which gives the likely antibiotic resistance for most organisms.
The appendices of this book are most useful. In Appendix 1 the adverse drug reactions are subclassified by their frequency which is actually given numerical status in the introduction.
Appendix 3 is a set of desensitisation protocols for antimicrobial therapy. This is extremely useful for remote and rural practice where alternative medications may not be available for several days, and in circumstances where life-threatening infections require an antibiotic to which the patient is sensitised. Appendix 10 provides a reproduction of the CARPA antibiotic guidelines which are well used by nurses and general practitioners in remote areas.
The guidelines on intravenous antimicrobial use in Appendix 6 could be an Australia-wide standard for hospitals, and home intravenous antibiotic therapy. Appendix 7 contains a guide on monitoring of blood levels with due emphasis on aminoglycosides. Appendix 8 provides a useful guide on paediatric dosing, while Appendix 9 deals with dosing during lactation and pregnancy and Appendix 11 advises on dosing in renal impairment with and without dialysis.
I have a dislike of guidelines that do not quote supporting evidence to help practitioners judge the reliability of the recommendations. To add references would swell the volume beyond pocket size, but without them the guidelines could appear to be based only on expert opinion. The detail of these guidelines also demands a more useful retrieval system than flicking through a book. Although an electronic version is available for use on a personal computer, more portability would be useful.*
Overall, this is an excellent little book. It should be owned by all prescribers in book or electronic form for quick reference.
* Editor’s note:
The supporting references are available in the electronic version of the guidelines (eTG Complete) and a palmtop format is being considered.
