A randomized trial published in JAMA Ophthalmology has found that a short course of azithromycin achieved similar relief of severe meibomian gland dysfunction (MGD) as a standard doxycycline regimen, but with fewer adverse events (AEs). After 6 weeks of follow-up, weekly azithromycin for 3 weeks was found to have a similar reduction in total MGD score and the Ocular Surface Disease Index as compared with 6 weeks of doxycycline. The study found that the azithromycin regimen caused almost a fourfold reduction in gastrointestinal AEs. MGD arises from terminal duct obstruction or changes in glandular secretion leading to the production of bacterial lipolytic enzymes, tear-film instability, and ocular surface inflammation. The condition has an estimated global prevalence of 36%, surpassing 50% in East Asia. For moderate or severe MGD, a 6-week course of doxycycline is common, but compliance with the extended regimen and frequent gastrointestinal AEs make the treatment problematic. Several different azithromycin regimens have been evaluated in MGD, most involving shorter-duration treatment. This study found that dosing azithromycin 1 g per week for 3 weeks (pulsed dosing) for MGD provides effective drug tissue levels for more than 1 month with a treatment regimen that could result in better patient compliance than therapies requiring daily dosing.
