how and when to prescribe

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Blair Lonsberry, MS, OD, MEd, FAAO, professor at Pacific University in Oregon, speaks with Times® Optometry’ Kassi Jackson on highlights of his discussion titled “Simplifying Systemic Antibiotics,” which he presented at the 2022 American Academy of Optometry (AAOpt) Annual Meeting in San Diego.

Editor’s Note: This transcript has been edited for clarity.

Jackson:

Hello everyone. With me today is Dr. Blair Lonsberry, a professor at Pacific University in Oregon. He’s here to share highlights from his discussion titled “Simplifying Systemic Antibiotics,” which he is presenting at the 2022 meeting of the American Academy of Optometry this year in San Diego. Thanks to be here. Dr Lonsberry.

Lonsberry:

Thanks Kasi. It’s good to be here.

Jackson:

Yeah, so would you please dive into the nitty-gritty, share with us some key points from your presentation?

Lonsberry:

Yeah. So I think when it comes to prescribing antibiotics, optometrists do topicals very well. We do not hesitate to prescribe topical medications. But when it comes to oral medications, I think optometrists tend to be hesitant. And there are certain conditions where orals are the only way to treat certain conditions, especially all skin-related conditions… And I think optometrists still tend to be a bit hesitant because they don’t necessarily feel comfortable prescribing them.

So throughout the conference I just wanted to go over different conditions that we will see in our offices, and show them what type of antibiotics could be used and understand that we could treat similar conditions with several different antibiotics, because a patient may be allergic to one or perhaps a cost issue. So I wanted to make sure they knew they had a variety of different options for them.

What I also wanted to point out, in particular, is that we tend to use the penicillin group. And there are many patients who claim to have penicillin allergies. And the CDC recently came out and said, basically, if you have a penicillin allergy, you probably don’t. 90% of penicillin allergic patients are not actually allergic to penicillin. And even if they had one as a child, they tend to grow out of it. So [the CDC is] recommend any healthcare professional, [that if] the patient presents with a penicillin allergy to request that he undergo a penicillin test to confirm whether he does or not. The probability is that they probably don’t. And in particular, for eye care, it removes a large group of antibiotics that we mainly use, they are our reference. And if we take that group of drugs out, we don’t have many other options left.

Next, it suffices to review the different groups of antibiotics, speaking mainly of the penicillin group; for what conditions would we indicate it; what to watch out for if a patient is allergic or has a reaction to these drugs; and then some more recent information just about the antibiotics we use that can potentially cross-react with other drugs. In particular, something like Bactrim – or septra – which is used for MRSA infections. But patients on methotrexate, it could be fatal for that patient because it actually stops the production of blood cells in the bone marrow and so on. And it’s something that [has] just kind of for a while, but now hits the press a lot more.

So putting doctors at ease, but also taking precautions to make sure they’re also looking for drug interactions for drugs that patients might be taking.

Jackson:

And you know, you kind of touched on it, alluded to it, but why is it so important for optometrists to discuss this?

Lonsberry:

Well, most states now have the ability [for optometrists] prescribing oral medications is something that has taken a long time to pass laws in each of the states [for optometrists] be able to prescribe oral medication. And again, I don’t think a lot of doctors feel comfortable with that.

And when I did this conference originally, probably 7 or 8 years ago, I thought nobody would show up for the conference. And the first time I did, 500 people showed up. And I was surprised. And I think because people don’t necessarily feel comfortable with oral medications, and [in] oral medication, there is a lot of resistance building up. And there’s not…necessarily a lot of new groups and drugs coming out.

So knowing when to prescribe them, how to prescribe them, [and] what to do if it doesn’t work, it’s really important that we not only treat the conditions, but also don’t help encourage the development of resistance to certain drugs that we have.

One of the things I’m talking about is for adult prescriptions, we really don’t want to prescribe more than 7 days. If you don’t take care of this infection in 7 days, you should switch to another antibiotic, such as not extending this prescription for another 7 days. So if I do Augmentin I will switch to Keflex to try and get rid of this infection. And things like that are going to help not only to treat our patients, but also to stem this resistance problem that is growing with antibiotics.

Jackson:

What does this mean for patient care?

Lonsberry:

Yeah, so that means we, I think, again, patients come to us for their eye care, which means evaluating the tissues around the eye.

We don’t tend to do a lot of oral antibiotics for conjunctivitis and the things we would normally use topicals for, but I think patients still come to us for anything eye related. So infections around the eyelids, instead of having to refer them to a general practitioner who does not necessarily know much about the eyes, that we are the experts in this field.

And often, they are also emerging patients. They get an infection, and it’s an emergency, and it’s hard for them to get to a primary care doctor. It’s probably much easier to get in with us. And we should take care of it.

I get text messages all the time from friends who have eye infections saying, “What should I do? I went to emergency care and it’s not being taken care of.” And I say, “That’s because you should call me first.” Because we know what happens with the eye. So I think… that’s the most efficient way for patients to be taken care of. And it is also the most effective way for them to be taken care of.

Jackson:

Is there anything you’d like to be sure to add that we haven’t covered?

Lonsberry:

I just think I want doctors to be confident. They know what’s going on with the eyes and need to be confident when writing prescriptions. Nobody says you have to memorize everything, but you can search for information. But just to make sure they feel confident when prescribing. They work in the best interests of their patients.

Jackson:

Great. Well, Dr. Lonsberry, thank you very much for your time today.

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