PRESCRIBER'S LETTER - The Most Practical Alerts and Advice, for Prescribers, on Developments in Drug Therapy. Vol 6, No 10 & 11, October & November 1999, Jeff M. Jellin, Pharm. D., Editor, Therapeutic Research Center.

The October issue contains a timely letter to physicians concerning prescribing, which is of vital importance if we don't want to be "left in the dust." The Web will change the way prescriptions are handled. Prescription pads are on the way out--electronics are in. Soon your orders will go from hand-held devices to larger computers in the office or clinic for transmittal via the Web. In the beginning stages, Rxs will be typed in. . . then computers will learn to recognize your handwriting . . . then your voice. Your orders will go to Web sites . . . then to the pharmacist . . . along the way there might be checking for formulary compliance . . . drug interactions . . . duplicate prescriptions, etc. Many patients will order Rxs and refills online. The big chains will have their own Web sites. Small independent pharmacies are joining huge networks. Security won't be a big issue. . . the techies are making significant improvements. Several places can help you create your own Web site . . . Locateadoc.com; doctornet.com; mednet-tech.com. You can even get a site that ends with ".md" instead of ".com." For details, go to www.nic.me. If you're into all this Web stuff, check out mdnetguide.com, too.

The November letter reviews the new approaches to controlling flu. The AAFP now recommends vaccinating ALL adults starting at age 50. With vaccination only 70-90% effective in health young adults and less so in the elderly, there is more interest in new antivirals for flu. The new ones, Relenza and Tamiflu hit both type A and B whereas the older ones, Symmetrel and Flumadine are useful only for influenza type A. . . The pharmacists have noted that physicians are now prescribing Zithromax for acne. It is as good as minocycline and is better tolerated and can be given less often, usually in a "pulse" regimen. Some use Zithromax 250 mg 2 or 3 times a week, others use a Z-pack once or twice a month or a Z-pack a month for premenstrual acne. The downside is cost and hence is recommended only if the usual antibiotics don't work or are not well tolerated.

These Letters for physicians by pharmacists give us concise and practical advice and alerts in the drug arena. A nice companion to the Medical Letter.