The Therapeutics Initiative operates at arms length from government and other vested interest groups. Our function is unbiased review and dissemination of therapeutic evidence. Assessments apply to most patients; exceptional patients require exceptional approaches. We are committed to evaluate the effectiveness of our educational activities using the Pharmacare database without identifying individual physicians, pharmacies or patients.

Therapeutics Letter, issue 5, March 1995

Anti-infective Guidelines for Community-Acquired Infections

We were pleased to provide recipients of the Therapeutics Letter in March 1995 with the booklet Anti-infective Guidelines for Community-acquired Infections, prepared by the Ontario Anti-infective Review Panel. This booklet provides you with the first-choice anti-infective drug(s), usual dosage and cost, for most of the community-acquired infections which you will likely encounter in your practice.

The guidelines were designed to be an educational tool to help promote appropriate use of anti-infective medications, how ever they are not intended to replace a physician's judgment. The cost information is specific for Ontario, but is still useful in B.C. because the relative costs of different antibiotics is for the most part standard across Canada. We hope that you will get it (if you didn't do it already) and keep it as a handy reference guide.

Copies of this booklet can be obtained from:
Publications Ontario, 50 Grosvenor Street, Main Floor, Toronto, M7A 1N8, Canada.
Telephone (416) 326-5300.
(MasterCard and Visa accepted; cheques and money orders payable to the Minister of Finance; prepayments required)

As you are all aware, it is important to weigh the risks and benefits when prescribing any medication, but this is particularly important when prescribing antibiotics. All antibiotics are associated with significant risks to the individual and to society. The major risks to the individual are immunological reactions and complications arising from alterations of normal flora, such as C.Difficile colitis. The major risk to society is the development of pathogenic bacteria with multiple antibiotic resistance. For the most part the magnitude of these risks is small, but immunological reactions to antibiotics can be severe and are occasionally fatal. For this reason it is never justified to prescribe an antibiotic when there is little or no chance of benefit. The dilemma the doctor frequently faces is exemplified by the cartoon.

 What should the doctor do when faced with the patient requesting an inappropriate prescription?

 There are a number of publications on the discomfort of prescribing under patient pressure. (Brit.MedJ.304:294,1992) One recent paper describes an ecxercise which was used to train practitioners how to decline inappropriate prescription requests.(Educ.Gen.Proc.5:112,1994) We would appreciate hearing from you if you have any personal strategies that might be helpful to our collegues.

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©Therapeutics Initiative. Last updated: December 4, 1995.