Friend's eyelid was all swollen and red and teary. His ophthalmologist prescribed moist compresses and Tobradex rubbed into the lashline, which costs $90 for a small tube or $55 under HealthNet. Since his eye was getting better by the time he saw the doc, he decided to wait a week and see what happens. It's still getting better, so I suspect he'll forget about the magic goo. I looked it up in the PDR. Is there anything special about this stuff that cheaper antibiotics won't do? Doctors just never seem to think about the cost of prescriptions. -- Cheers, Bev ======================================================================= "Windows Freedom Day: a holiday that moves each year, the date of which is calculated by adding up the total amount of time a typical person must spend restarting windows and then determining how many work weeks that would correspond to." -- Trygve Lode
Nothing "special" about it but combination agents (in this case, an antibiotic and steroid) do tend to cost more than just the antibiotic. I prescribe what it best for the patient but am aware what the meds cost. In my case, my patients are fortunate for, with their HMO plan, they just have a minimal co-payment for the meds. Interesting though, some of my patients get upset when an OTC (over the counter) medication is recommended because they have to pay full cost- some "insist" on getting a prescription med. In your case for your friend, an otc tube of polysporin ointment costing a few dollars would likely have done the trick anyway unless there was a significant inflammatory reaction. Even though it's not labeled for opthalmic use, the only real difference is the "graininess". frank
Perfectly understandable. Back when I had insurance I got Nicorette (1990 or so) for $3 for 3 months' worth by mail order. At current OTC prices I wouldn't dream of using it, especially in the summer when the gum would soften and stick to the very-nearly-unopenable container and cause more stress than what it was supposed to reduce. I thought that as soon as something went OTC insurance would no longer pay for it even with a prescription. I'll pass it on. I saw him this morning but had completely forgotten about it and neither noticed nor asked him about it. Must have been better or I'd surely have noticed the yuckiness.
The purpose of Tobradex is mainly to line the ddrug companies pockets but having a concoction that they have a patent on. Tobradex is a tradename, and no one else can make this particular formulation. You can get generic tobramycin, and you used to be able to get dexamethasone ointment, and use both of them, much more cheaply. They stopped making dexamethazone ointment, however. In general, I never use an aminoglycoside like Tobrex or gentamicin to treat blepharitis, which this is. Many doctors do, and it makes no sense. Most blepharitis is caused by gram-positive bacteria, and the spectrum of these drugs is mainly for gram-negatives. Yes, in high concentrations locally that can also kill gram-positives, but why not use something more appropriate? Note also that 90% of the treatment is the heat - it empties the oil glands, and increases circulation through the lids bringing in more of the body's natural antibodies and macrophages to kill the bacteria that the medictio won't even reach. Then I use sulfa drops daytime and erythromycin ointment at bedtime. If a steroid is needed, use Blephamide of Vasocidin drops, which have sulfa and a mild steroid. If allergic to these, I use generic Polytrim drops and generic Polysporin (ophthalmic) ointment - it goes in the eye, not just on the lashes. Need to carry out the hot soaks and mediation for at least 2 weeks, sometimes up to 3 or 4 weeks. It is stubborn. (For womem, discard the now-infected mascara and liquid eyeliner tubes to prevent reinfection.) David Robins, MD Board certified Ophthalmologist Pediatric and strabismus subspecialty Member of AAPOS (American Academy of Pediatric Ophthalmology and Strabismus) _______________________
Thanks, I forwarded this to my friend just in case. I think his eye cleared up by itself because I didn't notice it and even forgot that he had it a week later.
