Letters to the Editor

(Aust Prescr 1996;19:92-3)

Letters, which may not necessarily be published in full, should be restricted to not more than 250 words. When relevant, comment on the letter is sought from the author. Due to production schedules, it is normally not possible to publish letters received in response to material appearing in a particular issue earlier than the second or third subsequent issue.

Phenoxymethylpenicillin

Editor, - I noted in the segment 'Your questions to the PBAC' (Aust Prescr 1996;19:6-7) a concern expressed regarding the need for an increased PBAC listing for phenoxymethylpenicillin from 25 tablets. In the 9th edition of the 'Antibiotic Guidelines' the recommended course of treatment for acute sore throat caused by Streptococcus pyogenes is phenoxymethylpenicillin 500 mg 12 hourly for 10 days, which would be adequately covered by the current listing of 25 x 500 mg capsules or filmtabs. This may of course not hold for suspensions where 2 x 100 mL may be necessary for a full course.

Peter Shanahan
Director, Health and Medical Services
BHP Medical Centre
Melbourne, Vic.

The Editor comments:
The 'Antibiotic Guidelines' do suggest that adults with streptococcal sore throats can be treated with 500 mg of phenoxymethylpenicillin twice a day. This is a convenient regimen and 25 tablets would be enough for a 10 day course. However, this is an example of where the Guidelines can differ from the approved product information (PI) which is the usual guide to the PBAC on how drugs are listed on the Pharmaceutical Benefits Scheme. Until the recent amendment, patients who were prescribed the dose recommended in the PI (250 mg 4 times a day) had to pay for a repeat prescription to complete a 10 day course as the maximum quantity was only 25 tablets.

The new maximum quantity of 50 tablets will meet the needs of doctors who follow the PI as well as those who use the Guidelines. As the pack sizes are unchanged, Dr Shanahan can still write a prescription for 25 tablets.

Ideally, the prescription for a 10 day course should be 20 tablets for 500 mg twice a day or 40 tablets for 250 mg 4 times a day. However, prescribing less than the maximum quantity raises the issue of broken packs for the pharmacist.

Eye of Horus

Editor, - Continuing references to the Sacred Eye of Horus in Australian Prescriber have been of interest to myself, and they have finally galvanised me into action.

I have had the symbol for the Sacred Eye of Horus on either side of the bow of my fishing boat for some 7 or 8 years now, in the pious expectation that Horus will hear my prayer, and will lead me to a good fishing spot.

On the stern of my boat is an inscription which says 'The Gospel according to St John, chapter XXI verse 6'.

For some reason, my wife cynically accuses me of 'having two bob each way'.

Peter Lambert
Dental Surgeon
Carseldine, Qld

Reports of adverse hepatic reactions

Editor, - I refer to the Australian Adverse Drug Reactions Bulletin Vol. 15 No. 2 May 1996. In that issue, Table 1 'Reports of adverse hepatic reactions' is very sobering indeed. The ranitidine, diclofenac and phenytoin figures are particularly worrying. Could you publish the DDDs for these as well? Their % fatality for the number of reactions reported is higher than the top two (flucloxacillin and amoxycillin/potassium clavulanate).

John J. Byrne
General Practitioner
Ramsgate, N.S.W.

The Editor comments:
The graphs opposite are produced with the assistance of both the Drug Utilization Sub-Committee of the Pharmaceutical Benefits Advisory Committee and the Adverse Drug Reactions Advisory Committee.