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...a comprehensive reference that reviews all the major microorganisms and that covers all aspects of drug use for these microorganisms...also offers unique information on the empiric selection of therapy in a clinical setting.
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In this era in which pathogens are emerging, patterns of susceptibility to antimicrobial drugs are evolving, and new antimicrobial agents are becoming available, this new reference book, which is targeted to physicians and clinical pharmacists interested in antimicrobial chemotherapy, fills an important and unique niche. Beginning with the preface, the editor-in-chief, Victor Yu, makes clear the editors' commitment to provide readers with current information in a user-friendly format. In fact, Yu solicits comments and criticisms, recommendations for additional coverage, and suggestions for the authors and provides addresses so that readers can communicate with him by mail or e-mail. The editors have ambitious plans for subsequent expanded editions and for CD-ROM and Internet editions that will make frequent updates readily available.
The book is organized in sections on bacteria, fungi, and viruses. Within each section are subsections containing chapters on specific organisms and subsections on drugs that are used in treating those pathogens. The pathogen-specific chapters include a comprehensive review of in vitro susceptibility and appropriate therapy, with attention to special clinical situations. Where applicable, there are brief discussions of the prevention of infection by immunization or antimicrobial prophylaxis. Some of these chapters delve into the microbiology of the organism, the pathogenesis of various infections, and diagnostic strategies. Other chapters focus immediately on therapy and prevention. The drug-specific chapters include descriptions of the classes and structures of the drugs and discussions of their mechanisms of action, antimicrobial activity, mechanisms of microbial resistance, pharmacokinetics, and pharmacodynamics, as well as clinical implications, toxicity, dosage regimens, interactions (with other drugs or with food), and clinical indications.
This reference book has numerous attractive features. The overall organization is clearly reflected in the table of contents, and within each section the chapters on pathogens and on drugs are presented in alphabetical order. The chapters are generally well written; the tables are clear, well organized, and comprehensive; and the bibliographies are fairly current. Controversies in management are discussed where appropriate. The projected availability of updates on CD-ROM or on the Internet will ensure that this valuable reference book will remain current.
As is often the case in multiauthored books, there is great variability among the chapters. There was obviously an attempt to provide a template for organization within chapters. However, some authors varied the order of sections within their chapters and the degree of emphasis on areas that they covered. The editors might consider tightening their editing to ensure greater uniformity among the chapters so that readers can locate information more efficiently. For example, it is unnecessary to provide more than a very brief overview of clinical manifestations and diagnosis in a reference book that focuses on treatment. Navigation through the book would also be facilitated if the title of each chapter was provided at the top of its pages.
There is less attention paid to vaccines than the title of the book implies. With a few exceptions, the discussions of vaccines in the pathogen-specific chapters are less comprehensive than the descriptions of antimicrobial therapy. We were surprised to find no mention of vaccination in the chapter on Borrelia burgdorferi, even considering that a vaccine has only recently been approved for clinical use. However, the omission of immunization from the chapter on Streptococcus pneumoniae is glaring. Strengthening this aspect of the book would make it even more valuable.
A comprehensive presentation of therapy for human immunodeficiency virus (HIV) infection may be beyond the purview of this type of book, given the rapid increase in knowledge regarding antiretroviral therapy, the expanding armamentarium of anti-HIV drugs, and the changing understanding of combination chemotherapy for HIV infection. However, the editor's plans for updates make possible a truly comprehensive and detailed discussion of anti-HI\xd7 therapy that could be updated as frequently as warranted.
In summary, although there are approaches we might have taken if we had been editing this book, we consider it a work in progress that will no doubt evolve in response to feedback from readers as well as the demands of a rapidly growing data base of information. This book is a welcome addition to the reference literature, and we have recommended it as the graduation gift to our departing fellows.
Reviewed by Stephen A. Lerner, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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