Azithromycin improves Meibomian gland dysfunction with lesser GI side effects

A recent study by Phit Upaphong and colleagues shows that, azithromycin and doxycycline have similar impacts on the meibomian gland dysfunction (MGD) score and Ocular Surface Disease Index (OSDI) score at both follow-up intervals. The findings of this study were published in the Journal of American Medical Association.

Oral doxycycline takes a 6-week course of treatment to treat moderate to severe meibomian gland dysfunction and frequently causes adverse effects (AEs), which may be linked to low compliance. Consequently, the purpose of this study was to ascertain if the adverse events (AEs) associated with a 3-week course of oral azithromycin were comparable to those associated with a 6-week course of oral doxycycline.

From September 2018 through May 2022, a referral facility in Thailand hosted this double-masked, random clinical research. Individuals were deemed to have moderate to severe MGD and to be non-responsive to conservative therapy. The administration of oral doxycycline or oral azithromycin to patients was randomised at a 1:1 ratio (200 mg daily for 6 weeks).

The trial team evaluated the total MGD score, the Ocular Surface Disease Index score, and the adverse events (AEs) during the initial visit, at 6 weeks, and at 8 weeks after the start of medication. For the MGD score and OSDI score, the predetermined equivalence margins were set at 2 and 9, respectively.

The key findings of this study were:

1. 68 eyes from the azithromycin group and 69 eyes from the doxycycline group out of a total of 137 eyes from 137 patients were randomly assigned to each group.

2. At weeks 6 and 8, the adjusted mean difference in total MGD scores between the groups was 0.33 and 0.13, respectively.

3. At weeks 6 and 8, the adjusted mean difference in OSDI scores across groups was 1.20 and 1.59, respectively.

4. Azithromycin-treated patients also saw fewer GI adverse events.

The azithromycin group did not exhibit increased GI adverse events, according to the study. The use of azithromycin as a doxycycline substitute for at least 6 weeks is supported by the lower dose and maybe fewer gastrointestinal adverse events associated with it.


Upaphong, P., Tangmonkongvoragul, C., & Phinyo, P. (2023). Pulsed Oral Azithromycin vs 6-Week Oral Doxycycline for Moderate to Severe Meibomian Gland Dysfunction. In JAMA Ophthalmology. American Medical Association (AMA).

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