Oral antibiotics not effective in MGD?

Anyone who treats ocular surface disease (OSD) recognizes the important role oral antibiotics play in therapy, especially in patients with meibomian gland dysfunction (MGD). Yet the existing evidence is insufficient to conclude the effectiveness of oral antibiotic therapy, according to a report published in Ophthalmology.¹

The authors reviewed the existing medical literature and limited their review to original research that evaluated the role of oral doxycycline, minocycline, and azithromycin in OSD among adult patients. The authors found that “only a few studies that have assessed the efficacy of oral antibiotics in clinically meaningful ways in the management of OSD that arises from disorders of the meibomian glands.” The researchers did not say that antibiotics are not beneficial.

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In fact, they say, “The absence of such documentation certainly does not indicate that oral antibiotics do not have benefit in the treatment of OSD, but the current literature does not definitely demonstrate a benefit in using these therapies…(the studies) document improvements both in clinical symptoms and the health of the tear film.”

I base most of my treatment decisions on what I’ve seen work in the past for my patients. What I’ve seen with my own eyes, free of bias and commercial influence. I have used doxycycline and minocycline because of their antimicrobial, anti-inflammatory, and anti-metalloproteinase properties very effectively in the past. I have recently begun using azithromycin, initially based on the results of a British study,² but more frequently because I’ve seen this drug’s effects on my MGD patents. Azithromycin inhibits pro-inflammatory cytokines-earlier studies had shown the efficacy of azithromycin in chronic inflammatory diseases such as MGD.^3,4 So from a practical clinical perspective, we know these meds work.

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This paper actually illuminates a great opportunity for optometry. The paper points out there is no Level I research supporting MGD therapy. As our profession claims to own ocular surface disease, this would make a nice double-blind, placebo-controlled research project for optometry to design and conduct, and most likely definitively prove that oral antibiotic treatment for our patients is a safe and effective therapy for MGD.

References

1. Wladis EJ, Bradley EA, Bilyk JR, et al. Oral antibiotics for meibomian gland-related ocular surface disease. A report by the American Academy of Ophthalmology. Ophthalmology. DOI: http://dx.doi.org/10.1016/j.ophtha.2015.10.062. Accessed 12/30/15.

2. Kashkouli MB, Fazel AJ, Kiavash V, et al. Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial. Br J Ophthalmol. 2015 Feb;99(2):199-204.

3.Foulks GN, Borchman D, Yappert M, et al. Topical azithromycin therapy of meibomian gland dysfunction: clinical response and lipid alterations. Cornea. 2010 Jul;29(7):781-8.

4.Bertino JS Jr. Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics. Clin Ophthalmol. 2009;3:507-21.