Letters

Concern About Using Antibiotics for Viral Disease

■ I am writing to express my concern about the June 2012 Ophthalmology Management supplement, Considerations in the Treatment of Infectious Conjunctivitis, authored by John R. Wittpenn, MD, FACS, and sponsored by Bausch + Lomb, recommending treating infectious conjunctivitis with Zylet (loteprednol etabonate 0.5%/tobramycin 0.3%, B + L).

Infectious conjunctivitis is a benign, self-limiting disease. Untreated cases, whether viral or bacterial, resolve spontaneously in 7-9 days. Good clinical studies show treating bacterial cases with virtually any antibiotic improves symptoms sooner and time to total resolution is improved by 1.5 days. Using antibiotics to treat viral illnesses is a leading cause of unnecessary antibiotic use and is associated with increased antibiotic resistance.

While I’m sure B + L would like nothing better than to sell more antibiotics, especially expensive ones, is that really in our patients’ best interest?

— Dale I. Pollack, MD Keene, N.H.

Dr. Wittpenn responds: Dr. Pollack makes some legitimate points about the treatment of infectious conjunctivitis. In most cases it will spontaneously resolve in 9-14 days. However, treatment of bacterial conjunctivitis will speed resolution to as short as 3-7 days. In terms of getting a child back to school or an adult back to work, this shortening of even a few days can be important.

It is also true that an antibiotic has no effect on the duration of infectious activity of viral conjunctivitis. However, its inflammatory symptoms can be visually disabling, again prolonging one’s ability to return to normal function. I have been fortunate to have never experienced viral conjunctivitis myself. However, every ophthalmologist I know who has had viral conjunctivitis has self-treated with a steroid such as loteprednol. It is safe and relieves symptoms, and allows them to return to normal function quickly. If we do it to ourselves, why would we not do it for our patients?

Thank you for your consideration.

Neither ‘Perp’ nor Provider Does a Physician Make

■ I read your January 2013 editorial and sympathize with you. The cover of Ophthalmology Management, showing a surgeon’s gloved hands bound with red tape under the headline “Not What the Doctor Ordered,” portrays how you must feel. But images of surgeons in the perpetrator pose are degrading to our profession. How can anyone else hold us in esteem when we portray ourselves in such degrading images? Worse, the red tape looks like we should submit and enjoy being made into “perps.”

We need solutions, not problems. With regard to that cover story, I just had a Medicare drug plan deny a patient Pataday (olopatadine, Novartis). The patient looked up the recommended substitute on line and found that it could cause corneal melts and perforations. She was outraged at being asked to use the substitute and then having to prove it was contraindicated before she could ask for prior approval for the brand name.

A fitting image might be a patient with a perforated cornea testifying in court as politicians and Medicare Part D decision-makers stand handcuffed for practicing medicine without a license.

And, again, I ask all editors to stop calling me a “provider.”

— Eileen Marie Wayne, MD, Moline, Ill. OM