Systematic review and meta-analysis of treating meibomian gland dysfunction with azithromycin

Abstract

To systematically review studies of managing meibomian gland dysfunction (MGD) with azithromycin and pool clinical outcomes to show its effectiveness. Eligible studies were retrieved from five main electronic databases. Symptom score was the primary outcome, while clinical signs and objective measurements were secondary outcomes. Pooled rates for adverse events were also calculated. Improvements in each outcome after administering either oral azithromycin (OA) or topical azithromycin (TA) were pooled and measured by standard mean difference (SMD) to show the overall effectiveness. Then the effectiveness was sub-grouped by TA and OA. In addition, pooled outcomes after administering TA and oral doxycycline (OD) were compared with assess their effectiveness. Finally, 18 eligible studies were included. The overall pooled symptom scores were significantly reduced after administering both TA and OA [P < 0.0001; SMD = 1.54 (95% CI: 1.15-1.92)]. Similarly, the overall combined eyelid signs, plugging of the meibomian gland, meibum quality, and tear secretion were also distinctly improved. However, significant improvements for tear break-up time (TBUT) and corneal staining (CS) were achieved by TA (TBUT: P = 0.02; CS: P = 0.02) but not by OA (TBUT: P = 0.08; CS: P = 0.14). The pooled adverse event rates for TA and OA were 25% and 7%, respectively. Moreover, TA was comparable to OD to treat MGD regarding symptom score, TBUT and tear secretion. This study showed that MGD could be treated effectively with oral or topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Topical azithromycin seemed to be superior over oral azithromycin or doxycycline in improving the quality of tear film in the short term.

The preoperative management of meibomian gland dysfunction prior to corneal refractive surgery

“…Both azithromycin and tetracycline derivatives have been shown to improve MGD symptoms and meibomian gland function. A recent meta-analysis of 15 trials examining oral and topical azithromycin treatment by Tao et al [45] demonstrated significant improvements in symptom scores, meibomian gland physiology and tear film characteristics. Similar findings have been found in clinical trials using oral tetracyclines [46,47].…”

Current treatment modalities for dry eye disease

“…Так, например, антибиотики тетрациклинового ряда (доксициклин) ингибируют продукцию бактериальных липаз, улучшая тем самым липидный профиль мейбомиевых масел. Местное применение азитромицина оказывает и антибактериальное, и противовоспалительное действие [39,40].…”

Antibiotic treatment for dry eye disease related to meibomian gland dysfunction and blepharitis – A review

“…However, the World Health Organization advises limiting the prescription of antibiotics to slow the development of antibiotic resistance [12]. Recent reviews have found that oral and topical antibiotics are effective in treating MGD and MGD-related DED, especially in the short-term [13][14][15][16][17]. However, despite their widespread use, level I clinical evidence (randomized, placebo-controlled trials) supporting the use of oral antibiotics in the treatment of MGD and MGD-related DED is limited [13,14,16].…”