| In vitro: |
| J Pediatr Ophthalmol Strabismus. 2014 Nov-Dec;51(6):363-9. | | Use of atropine penalization to treat amblyopia in UK orthoptic practice.[Pubmed: 25427306] | To compare clinical practice patterns regarding Atropine penalization use by UK orthoptists to the current evidence base and identify any existing barriers against use of AP as first-line treatment.
METHODS AND RESULTS:
An online survey was designed to assess current practice patterns of UK orthoptists using Atropine penalization. They were asked to identify issues limiting their use of Atropine penalization and give opinions on its effectiveness compared to occlusion. Descriptive statistics and content analysis were applied to the results. Responses were obtained from 151 orthoptists throughout the United Kingdom. The main perceived barriers to use of Atropine penalization were inability to prescribe Atropine and supply difficulties. However, respondents also did not consider Atropine penalization as effective as occlusion in treating amblyopia, contrary to recent research findings. Patient selection criteria and treatment administration largely follow current evidence. More orthoptists use Atropine penalization as first-line treatment than previously reported.
CONCLUSIONS: Practitioners tend to closely follow the current evidence base when using Atropine penalization, but reluctance in offering it as first-line treatment or providing a choice for parents between occlusion and Atropine still remains.
This may result from concerns regarding Atropine's general efficacy, side effects, and risk of reverse amblyopia. Alternatively, as demonstrated in other areas of medicine, it may reflect the inherent delay of research findings translating to clinical practice changes. |
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| In vivo: |
| J Community Support Oncol. 2015 Jan;13(1):3-7. | | Use of atropine-diphenoxylate compared with hyoscyamine to decrease rates of irinotecan-related cholinergic syndrome.[Pubmed: 25839059] | To compare the incidence of cholinergic syndrome with irinotecan using Atropine-diphenoxylate or hyoscyamine as premedication.
METHODS AND RESULTS:
We conducted a retrospective, single-center, nonrandomized, cohort study of adult patients treated with Atropine-diphenoxylate or hyoscyamine as premedication before receiving irinotecan. For all irinotecan infusions, intravenous Atropine was administered for patients experiencing any cholinergic reaction. A total of 532 irinotecan cycles (354 cycles for Atropine-diphenoxylate group; 178 cycles for hyoscyamine group) were analyzed in 80 patients. Overall incidence of cholinergic syndrome did not differ between Atropine-diphenoxylate (8.2%) and hyoscyamine (9.0%) groups (P = .76). The incidence of cholinergic syndrome after the £rst cycle of irinotecan was similar between the 2 arms, Atropine-diphenoxylate (14.6%) and hyoscyamine (10.7%), with P = .74. The most common cholinergic symptoms documented were abdominal pain or cramping, and diarrhea. This study was subjected to vulnerabilities to bias and random error because of its observational retrospective design and small number of participants.
CONCLUSIONS:
Lack of difference in the incidence of cholinergic syndrome observed in irinotecan-treated patients suggests Atropinediphenoxylate and hyoscyamine may both be effective prophylactic options. The findings support the need for a larger, randomized study to assess and compare these agents with other potential premedications such as scopolamine and Atropine in prevention of irinotecan-related cholinergic syndrome. | | Ther Adv Cardiovasc Dis. 2014 Oct;8(5):176-84. | | Atropine first is safer than conventional atropine administration in older people undergoing dobutamine stress echocardiography.[Pubmed: 24906705] | Early injection of atropine during dobutamine stress echocardiography (DSE) has been demonstrated in retrospective analyses to reduce the duration and dose of dobutamine infusion, while preserving a similar diagnostic accuracy with a lower incidence of adverse effects. This study explores the safety of using atropine as a start drug before dobutamine infusion (ADSE protocol) in comparison with the conventional protocol (DASE protocol) in older patients undergoing DSE for ischemia evaluation.
METHODS AND RESULTS:
One hundred consecutive older patients were prospectively enrolled. When eligible, they were randomly assigned to undergo either the DASE protocol (group A, 50 patients) or the ADSE protocol (group B, 50 patients) when atropine (1.0 mg) was first administered 3 min before dobutamine infusion followed by 0.5 mg increments (maximum 1.0 mg) thereafter. Patients were monitored for adverse drug effects. Test duration was calculated.
The mean age of the whole study cohort was 67.8±4.3 years and 58 (58%) were men. Patients in group A had longer test duration (21.8±1.3 versus 13.7±0.77 min, p<0.001) and higher mean dobutamine infusion rate (39±8.2 versus 28.2±9.5 μg/kg/min, p<0.001). The two groups received a similar total dose of atropine. Group A patients showed significantly higher incidence of extrasystoles, nonsustained ventricular tachycardia and severe hypotension (p<0.05).
CONCLUSIONS:
In older patients undergoing DSE, using atropine as a start drug, that is, adopting the ADSE protocol, is associated with shorter test duration, lower mean dobutamine infusion rate and consequently fewer adverse effects. |
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