Macrolides were superior to tetracyclines in both efficacy and safety when used for MGD management.

Macrolides were superior to tetracyclines in both efficacy and safety when used for MGD management. Photo: Doan Huynh Kwak, OD. Click image to enlarge.

Patients with meibomian gland dysfunction (MGD) seem to experience significant improvement with the low-tech, low-cost and highly available traditional method of systemic antibiotic administration. The two antibiotic groups used for MGD treatment are tetracyclines and macrolides. With growing bacterial resistance to antibiotics on one hand and the need for effective affordable treatment modalities for MGD on the other, it is crucial to determine the most effective and safe antibiotic treatment for MGD. A recent systematic review and meta-analysis published in Acta Ophthalmology addressed this issue by comparing oral macrolide with tetracycline antibiotic treatment for the condition. While both were effective, macrolides exhibited better efficacy and safety.

Six prospective studies were ultimately included for analysis, which reported on 563 cases from three countries. Affected patients with moderate to severe MGD ranged between the ages of 12 and 90. Individual study data was extracted and evaluated in a weighted pooled analysis, including total sign and symptom scores, meibomian gland secretion score, tear breakup time (TBUT), fluorescein staining score and rate of complications.

In pooled analysis, macrolides were significantly superior in the total signs score (pooled standardized mean difference: -0.51), meibomian gland secretion score (pooled standardized mean difference: -0.25), TBUT (standardized mean difference: -0.31) and fluorescein staining score (standardized mean difference: -1.01). Moreover, while no severe complications were reported for both treatments, the macrolide group exhibited significantly fewer adverse events (pooled odds ratio: 0.24).

“The analysis demonstrated a significant superiority of the macrolides in both efficacy and safety when used for MGD management,” the researchers concluded in their paper. “We believe that these results may aid clinicians in choosing their first-line treatment strategy for MGD patients in the future.”

Ben Ephraim Noyman D, Chan CC, Mimouni M, Safir M. Systemic antibiotic treatment for meibomian gland dysfunction-A systematic review and meta-analysis. Acta Ophthalmol. May 4, 2023. [Epub ahead of print].