Clinical Trials in Oculoplastics

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Oral azithromycin versus doxycycline 2015

Kashkouli MB, Fazel AJ, Kiavash V, Nojomi M, Ghiasian L. Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomized double-masked open-label clinical trial. Br J Ophthalmol. 2015 Feb;99(2):199-204. doi: 10.1136/bjophthalmol-2014-305410. Epub 2014 Aug 19. PMID: 25138765.

Objectives

The goal was to determine the efficacy and safety of oral azithromycin compared to doxycycline in patients with meibomian gland dysfunction (MGD) who had failed to respond to prior conservative management.

Methods

Clinical trial randomly assigning oral 5-day azithromycin (500 mg on day 1 and then 250 mg/day) or 1-month doxycycline (200 mg/day). Patients were >12 years old with posterior blepharitis who had not responded to conservative management: eyelid warming/massage/cleaning (4–5 min) twice a day and artificial tears (four times a day). They also continued eyelid warming/cleaning and artificial tears. A score comprising five symptoms and seven signs (primary outcome) was recorded before treatment and at 1 week, and 1 and 2 months after treatment. A total score was the sum of both scores at each follow-up. Side effects were recorded, and overall clinical improvement was categorized as excellent, good, fair, or poor based on the percentage of change in the total score.

Main outcome measures

Symptoms and signs related to MGD.

Limitations

Absence of a control group without any systemic medication.

Results

110 patients were included to receive either oral azithromycin for 5 days or doxycycline for 1-month. MGD symptoms and signs improved in both groups. The azithromycin group showed a significantly better overall clinical response, with more improvement of the bulbar conjunctival redness, and ocular surface staining. Doxycycline group had significantly more side effects.

Conclusions

Although both oral azithromycin and doxycycline improved the symptoms of MGD, 5-day oral azithromycin is recommended for its better effect on improving the signs, better overall clinical response and shorter duration of treatment.

Pearls for clinical practice

Oral 5-day azithromycin (500 mg on day 1 and then 250 mg/day) is a good option to treat MGD.

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