title: Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial.
abstract: OBJECTIVE
  To assess the efficacy and safety of oral azithromycin compared with oral doxycycline in patients with meibomian gland dysfunction (MGD) who had failed to respond to prior conservative management.
  
  
  METHODS
  110 patients (>12 years old) with MGD were randomly assigned to receive either oral 5-day azithromycin (500 mg on day 1 and then 250 mg/day) or 1-month doxycycline (200 mg/day). They also continued eyelid warming/cleaning and artificial tears. A score comprising five symptoms and seven signs (primary outcome) was recorded prior to treatment and at 1 week, and 1 and 2 months after treatment. Total score was the sum of both scores at each follow-up. Side effects were recorded and overall clinical improvement was categorised as excellent, good, fair or poor based on the percentage of change in the total score.
  
  
  RESULTS
  Symptoms and signs improved significantly in both groups (p=0.001). While improvement of symptoms was not different between the groups, bulbar conjunctival redness (p=0.004) and ocular surface staining (p=0.01) were significantly better in the azithromycin group. The azithromycin group showed a significantly better overall clinical response (p=0.01). Mild gastrointestinal side effects were not significantly different between the groups except for the second visit, when the doxycycline group had significantly more side effects (p=0.002).
  
  
  CONCLUSIONS
  Although both oral azithromycin and doxycycline improved the symptoms of MGD, 5-day oral azithromycin is recommended for its better effect on improving the signs, better overall clinical response and shorter duration of treatment.
  
  
  BACKGROUND
  NCT01783860.
authors.affiliation: Eye Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohsen Bahmani
authors.initials: MB
authors.lastname: Kashkouli
authors.affiliation: Eye Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali Jalili
authors.initials: AJ
authors.lastname: Fazel
authors.affiliation: Eye Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Victoria
authors.initials: V
authors.lastname: Kiavash
authors.affiliation: Epidemiology and Community Medicine Department, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Nojomi
authors.affiliation: Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Ghiasian
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use*; D005141:Eyelid Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D065346:Lubricant Eye Drops / Q000008:administration & dosage; D008297:Male; D008537:Meibomian Glands / Q000187:drug effects* / Q000473:pathology; D008875:Middle Aged; D013666:Tears / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D065346:Lubricant Eye Drops; D017963:Azithromycin; D004318:Doxycycline
keywords: Eye Lids; Inflammation; Microbiology; Ocular Surface; Treatment Medical