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Letter to the editor
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.
Editor's comment
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.