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Letter to the editor

Editor, – Case study: An 18-year-old female with a chlamydial pelvic infection was prescribed a prolonged course of doxycycline 100 mg twice daily. The prescription was written as the generic 'doxycycline'.

One week later the patient presented with a scaling rash on the face and dorsa of the hands, presumably the photosensitivity rash described as a possible adverse effect of tetracycline therapy. She produced her tablets: she had both 'Doryx' and Vibramycin' and had been taking two of each per day. Presumably the pharmacist had had insufficient stocks of either brand and so had dispensed some of each. Communication failure, both by me and by the pharmacist, had led to an inadvertent overdose by this patient.

The rash resolved within a week of withdrawal of the doxycycline.

How to prevent this? Either, do not prescribe generically, or force pharmaceutical companies to label their products with the generic names in the same size print as the trade names. The latter seems the preferable solution to me as patients receiving prescriptions from different doctors may still inadvertently make the same mistake as my patient.

Nick Silberstein
General Practitioner
Mount Barker, W.A.