On the prescribing of oral doxycycline or minocycline by UK optometrists as part of management of chronic Meibomian Gland Dysfunction (MGD).
OBJECTIVE
To review the special pharmacology of tetracycline antibiotics as anti-inflammatory drugs for treatment of obstructive Meibomian gland disease (MGD) METHODS: PubMed was used as principal resource for articles, regardless of language, on doxycycline and minocycline with key interests being on their serum and tissue pharmacokinetics and their use in clinical studies as part of management of MGD.


RESULTS
With oral dosing of between 50 and 200mg, peak blood levels of these antibiotics have been reported to be predictably dose-dependent at between 1 and 5 microgram/mL, with human tear film levels not being detectable with 100mg dosing of doxycycline but levels of 0.2 microgram/mL with 200mg minocycline. That these two tetracycline antibiotics reach the conjunctiva is indicated by conjunctival pigmentary changes due to photosensitization after very long term use. Based the reported use in a range of clinical studies on MGD, dosing with these two antibiotics for MGD is likely to be useful at relatively low doses (e.g. 100mg for doxycycline or 50mg for minocycline, either at once or twice daily depending on severity at presentation and previous history) continued for 2 to 3 months, with the expected outcome being small-to-substantial decreases in abnormal appearance of the glands (from -4 to -89%) and increases in tear film stability (from 21 to 273%).


CONCLUSIONS
Oral doxycycline and minocycline have predictable pharmacokinetics and have been reported to improve Meibomian gland dysfunction over a few months of use.
Glasgow-Caledonian University, Department of Vision Sciences, Cowcaddens Road, Glasgow G4 OBA. Electronic address: m.doughty@gcal.ac.uk.
Michael J
MJ
Doughty
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019468:Disease Management; D004318:Doxycycline / Q000008:administration & dosage*; D011307:Drug Prescriptions / Q000592:standards*; D005141:Eyelid Diseases / Q000188:drug therapy*; D006801:Humans; D008537:Meibomian Glands / Q000187:drug effects*; D008911:Minocycline / Q000008:administration & dosage*; D009907:Optometry; D006113:United Kingdom; D000078329:Workforce
D000900:Anti-Bacterial Agents; D008911:Minocycline; D004318:Doxycycline
Doxycycline; Dry eye; Meibomian gland dysfunction; Meibomianitis; Minocycline; Tetracyclines