James McCormack, Glen Brown, Marc Levine, Robert Rangno, John Ruedy
W.B. Saunders Company, 55 Horner Ave, Toronto, ON M8Z 4X6
Evidence-based approach for making drug therapy decisions
Missing key information
Any clinician who prescribes drug therapy, particularly useful for teaching practices
This book is not just another multi-authored reference book. It is designed to wean clinicians away from “habitual or intuitive solutions” and to encourage decisions based on explicit factors. To achieve these goals, the book has a section on drug therapy for disease states to help readers make therapeutic choices that are reasonable if not optimal and to provide information on initiating, altering, or terminating a drug.
For each clinical condition a set of questions is asked. For example, in treating depression, before choosing a therapeutic agent you are asked to consider treatment goals, evidence to support drug therapy, when to consider drug therapy, initial treatment, dosage, the length of the initial treatment regimen, the efficacy parameters and patient assessment interval, when to add an additional drug if initial therapy fails, and the length of drug therapy.
This is good medicine. The process reinforces a framework for making therapeutic decisions and subsequently managing patients appropriately. The text also has sections on common drug-induced adverse reactions and drug monographs. Both these sections use questions to develop rational therapeutic decisions.
No text is perfect. Inevitably some key information is missing. I could not find a specific therapeutic approach to necrotizing fasciitis. Also, the book does not provide advice on how to switch from one group of antidepressants to another. Nevertheless, once I got used to the directed format, I found it is easy to use and helpful in making reasonable if not optimal drug therapy decisions.