patanol side effects

2007-12-28T11:29:00.001-08:00

Letters to the Editor TO THE EDITOR: I read with interest the article, "Topical Tacrolimus: A New Therapy for Atopic Dermatitis,"1 because I recently saw a patient who experienced therapeutic failure with a $100 tube of tacrolimus for atopic dermatitis. Because the response rate with tacrolimus is 27 to 36 percent compared with a 6 percent response rate for the vehicle alone, there is little doubt that tacrolimus works better than other available therapies, such as oral antihistamines, topical emollients, topical doxepin, and topical corticosteroids. This information would help physicians decide whether to order such an expensive new treatment or stay with the available remedies. EDWARD P.

MCAULIFFE, M.D. Kaiser Permanente 899 Hwy 287 Broomfield, CO 80020 REFERENCE The article "Antidepressants: Update on New Agents and Indications" (February 1, 2003, page 547) contained an error in the description of venlafaxine. On page 551, the second sentence under the subheading "Venlafaxine" should have read: It is a bicyclic antidepressant that produces strong inhibition of norepinephrine and serotonin reuptake. Send letters to Jay Siwek, M.D., Editor, American Family Physician, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672; fax: 913-906-6080; e-mail: afplet@aafp.org. Please include your complete address, telephone number, and fax number. Letters should allergic conjunctivitis be submitted on disk, double-spaced, fewer than 500 words, and limited to one table or figure and six references. Please submit a word count. Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission.

Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements. Copyright © 2003 by the American Academy of Ophthalmology3 and the British Public Health Laboratory Service4 do not offer specific recommendations for treatment of presumptive nonherpetic viral conjunctivitis. Considering the practical realities of parent expectations of antibiotic treatment for all cases of conjunctivitis in infants and toddlers, You are not alone in your approach to the treatment of viral conjunctivitis either provide no recommendation or recommend supportive treatment for viral conjunctivitis.

The extant evidence does not warrant the use of topical enlargement pills antibiotics for cases of low-risk viral conjunctivitis, such as cases that are not caused by herpes simplex virus or herpes patanol eye drop zoster; however, a recent survey1 of British general practitioners found that patanol side effects 95 percent of them prescribed topical antibiotics despite their belief that at least one half of the cases they saw were of a viral origin. Unfortunately, evidence-based guidelines on the treatment of viral conjunctivitis either provide no recommendation or recommend supportive treatment for viral conjunctivitis. The American Optometric Society recommends the use of topical antibiotics for all affected patients because of the low risk from treatment. WI 54822 REFERENCE IN REPLY: I would like to thank Dr. Bennett for his letter regarding the conflict between the pressure to treat all cases of conjunctivitis without treatment and the lack of evidence for benefit from topical antibiotics in cases of viral conjunctivitis, the low risk of treatment with topical antibiotics, and unclear policy guidelines, it would seem reasonable to pursue one of the following options. One option would be to combine clinical judgment with your knowledge of the parents' expectations and make individual recommendations given your level of certainty of the diagnosis and implications on the physician-patient relationship of your treatment decisions. SEAN P.

DAVID, M.D., S.M. Brown University Center for Primary Care and Prevention 111 Brewster St. Pawtucket, RI 02860 REFERENCES TO THE EDITOR: I am a new practicing physician in northern Wisconsin and would like some guidance on the correct treatment of conjunctivitis. During my training in family medicine, both visiting with ophthalmologists and pediatricians, it became apparent that all patanol eye drop cases of conjunctivitis without treatment and the lack of evidence for benefit from topical antibiotics in cases of viral side effects of patanol eye drop conjunctivitis, and then allow the parents to choose. This is a reasonable option for practical reasons and because a large proportion of primary care physicians are uncertain about whether low-risk cases are viral or bacterial in origin.1 A second option would be to offer a delayed prescription approach by prescribing antibiotics only for those cases that have not resolved by day 5.5 In one qualitative study6 of adult patients with conjunctivitis, most patients preferred to wait a few days for treatment once they were made aware of the self-limiting nature of conjunctivitis. However, it is unclear whether parents would take the same attitude toward their children in day care, However, what should be done about the more common viral pink eye? It is frustrating as a physician to convince parents and day care staff that an antibiotic is not helpful in these cases and should not be used. I would welcome your advice and direction.

CRAIG BENNETT, M.D. Midelfort Clinic, Cameron Cameron, WI 54822 REFERENCE IN REPLY: I would like to thank Dr. Bennett for his letter regarding the conflict between the pressure to treat all cases of conjunctivitis in infants and toddlers, I can understand your dilemma..