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TitleDoxycycline vs Azithromycin for MGD and Blepharitis: Systematic Review of Published Clinical Trials
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PurposeTo review and assess the efficacy of doxycycline vs azithromycin in oral preparation for meibomian gland dysfunction (MGD) and blepharitis based on existing medical literatures.
MethodsA comprehensive literature search was last conducted on April 19, 2019, in PubMed/MEDLINE database. All English-language original research investigations of doxycycline and azithromycin for MGD or blepharitis with more than 10 subjects were included. Symptoms, MGD signs, tear break up time (TBUT) and ocular surface staining score were the main outcome measures in this review.
ResultsThe search identified 79 articles, of which 6 studies with total of 365 eyes were reviewed. Doxycycline was studied in 4 RCTs with wide variation of dosage for 3-4 weeks. Azithromycin was used in 4 studies (3 RCTs and 1 case series) and was given for 3-5 days. Two out of which administered the medication in 3 cycles. Both doxycycline and azithromycin were able to improve symptoms and MGD signs including gland plugging, eyelid hyperemia, and meibum secretion. One month after treatment cessation, TBUT reached 9.42±2.87 s and 9.75±5.83 s in doxycycline and azithromycin, respectively. Direct head to head comparison was conducted in 2 RCTs, in which excellent and good clinical response were 26.8-32% with doxycycline and 52-77.1% with azithromycin.
ConclusionDoxycycline and azithromycin are commonly used in the management of MGD and blepharitis. Azithromycin showed favorable results with shorter treatment duration and better clinical response compared to doxycycline. However, highly variable treatment method including dosage, duration and regimen is a potential bias in this review.
Conflict of interestNo
Author 1
Last nameNOOR
Initials of first name(s)NA
DepartmentOphthalmology
CityJakarta
CountryIndonesia