Oral Antibiotics: The Jury Is Still Out

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Ocular surface disease (OSD) affects some 15% of Americans 65 and older and is one of the most common reasons for a visit to the ophthalmolo­gist. Meibomian gland disease (MGD), which causes instability of the tear film, frequently contributes to OSD.

An Academy Ophthalmic Technology Assessment (OTA) has delivered a mixed message on the use of oral antibiotics to treat OSD related to MGD. After reviewing the literature, the OTA com­mittee found that while oral antibiotics appear to be beneficial in treating at least some patients with OSD, there is no level I evidence to support their widespread use.¹

Examining the literature. The review yielded 87 articles reporting investi­gations to evaluate the efficacy of oral doxycycline, minocycline, or azithro­mycin in managing OSD. Eight studies met the inclusion criteria for use in the final analysis, and each of these demon­strated some therapeutic benefit for the outcomes assessed. But how strong is the supporting evidence? Two of the 8 studies were graded as providing level II evidence, and 6 were graded level III.

“The studies demonstrated at least some utility, and the reported benefits were often quite robust,” said commit­tee member Edward J. Wladis, MD, associate professor of ophthalmology, Albany Medical College. He added, however, that further investigations are needed to confirm existing study results and to define the benefits patients may expect to receive for antibiotic therapy.

The dearth of studies for so com­mon a clinical scenario sur­prised Dr. Wladis. “Hopefully, stron­ger future studies will provide a clearer road map,” he said.

Clinical con­siderations. For now, he advised doctors to reserve antibiotic use for patients whose MGD has not responded to standard treatments, such as warm compresses and topical lubrication. He also warned doctors to be mindful of side effects in patients with worrisome allergies and comorbidities, such as a history of Stevens-Johnson syndrome or diffi­cult-to-manage anticoagulation.

“Clinicians should have open con­versations with their patients regarding possible side effects of these agents and the level of confidence that they should place in them,” Dr. Wladis said.

—Miriam Karmel

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1 Wladis EJ et al. Ophthalmology. 2016;123(3): 492-496.

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Relevant financial disclosures: Dr. Wladis—None.

For full disclosures and disclosure key, see below.

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