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Doxycycline comes in two forms: hyclate and monohydrate. While not a major factor, the monohydrate form is a bit more gastrointestinally friendly. Because of concern for altered enamelization of the teeth, it is not to be used in children under age 10 (some experts say age eight, but we are a little more conservative). Doxycycline maintains 90% of its potency four years after its printed expiration date and, contrary to older teaching, does not become toxic beyond its expiration date.1 • Penicillin “allergy” is extremely rare, and while the cephalosporins share a similar molecular structure to penicillin, a penicillin allergy would rarely preclude the use of any cephalosporin. If the patient has a history of true anaphylaxis, we would use either doxycycline or a combination antibiotic originally known as Bactrim or Septra. These are a combination of trimethoprim and sulfamethoxazole. Because of the sulfa component, we would not use it in a patient with a history of severe sulfa allergy. • Because of the rare event of devastating tendonitis and tendon rupture, we would never prescribe an oral fluoroquinolone. As an interesting aside, ciprofloxacin is also good four years past it expiration date.1 • Sort of like doxycycline having a dichotomous character, so too does oral prednisone. The difference here is more temporally related than dosing related. Long-term use of steroids (for longer than two weeks) portends an increasingly higher risk of legendary side effects; however, short-term use of prednisone carries little risk, especially at the typical dosing of 40mg to 60mg per day. If ever any questions regarding its use arise, never hesitate to consult with the patient’s primary care provider. For example, if we felt the need to use a higher dose (let’s say 100mg per day for initial therapy) in a patient suspected of having giant cell arteritis, we would make a quick call to the PCP just to make sure there was no reason that such a dosage would be inappropriate for this patient. Note that life is a Oral Medication Dos and Don’ts Some patients need the relief that only systemic administration can deliver. FACTS ABOUT CEPHALEXIN (KEFLEX) • Cephalexin — a first-generation cephalosporin • Effective against most gram-positive pathogens • Some earlier-generation cephalosporins share about a 1% cross-allergenicity to PCN • Usual dosage: 500mg BID x 1wk • Useful in soft tissue Staph. infections, such as internal hordeola, preseptal cellulitis and others This man presented with a four-day history of painful, tender and worsening redness to his right eyelids. He was treated with cephalexin 500mg BID along with aggressive use of warm soaks. REVIEW OF OPTOMETRY JUNE 15, 2020 27 team sport, and so we should all work together to help one another.
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