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Speaker: For inflammation, steroids should be used boldly
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ATLANTA — When making the decision to use steroids to treat inflammation, optometrists should prescribe an aggressive dosing frequency, according to a lecturer here at SECO.
“Don’t be timid about using steroids,” Jimmy D. Bartlett, OD, said during a therapeutics symposium sponsored by Allergan. “I’ve been finding out that the most optometrists are using a steroid is four times daily. That’s wrong. You don’t want to do that.
Jimmy D. Bartlett
“You want to hit the patient over the head,” Bartlett said. “You cannot overdose a steroid in the first couple of days. It’s always better to give the patient too much than not enough. You want your patients to have a full dose.”
The science behind that, he said, comes from an experiment conducted several decades ago by Lebowitz at Boston University, where he was able to quantify how much reduction of inflammation was achieved by simply adjusting the dosing frequency.
The study found that four-times-daily resulted in an 11% reduction of inflammation, that every 2 hours resulted in a 30% reduction, that every hour resulted in a 51% reduction, every 30 minutes a 61% reduction, every 15 minutes a 68% reduction and for one drop every minute for 5 minutes every hour, the inflammation dissipated by 72%, Bartlett said.
“There’s a pattern here. Can you see it?” he said. “The more frequently you dose the steroid, the greater the anti-inflammatory effect. So if you want a greater effect, give the patient the drug more frequently. If you want a lesser effect, you don’t change to a lower concentration drug, you simply back off on the dosing frequency. You can titrate the effect up or down just by changing the dosing frequency.
“When prescribing steroids, I like to do it once every 1 or 2 hours, for 24 hours, while awake. Then you can back off to four times a day,” Bartlett continued.