However, recent studies have shown that a lower dose of doxycycline is equally effective-without the potential side effects and risk of microbial resistance. Traditionally, clinicians often prescribed doxycycline dosages as high as 200mg/day for the treatment of MGD. With its demonstrated anti-inflammatory activity, however, doxycycline is an excellent adjunctive therapy for MGD management. Standard therapy for these conditions is lid hygiene, which includes the use of warm compresses and lid scrubs/massages to clean the debris from the lids and stimulate meibomian gland secretion. Blepharitis and MGD are common ocular conditions that result in significant ocular discomfort and visual disruption.Controlled-release doxycycline 40mg (Oracea, Galderma Laboratories) is also effective, and this specific combination has been found to be a useful alternative to higher doses of doxycycline. In my experience, most dermatologists prescribe 50mg to 100mg doxycycline or minocycline QD to BID for the treatment of rosacea. Ocular manifestations are common in patients with rosacea, with characteristic symptoms of redness, irritation or burning of the eyes. Affected patients usually present with complaints of flushing, blushing and sensitive skin. Rosacea is a chronic inflammatory condition of the facial skin.Rosacea is typically managed with 50mg to 100mg doxycycline QD to BID. For example––these medications have been shown to inhibit the production of pro-inflammatory mediators, thus reducing the production of inflammatory compounds such as cytokines and chemokines, and in particular, matrix-metalloproteineases (MMP). Several conditions have an indication for doxycycline treatment, including ocular/acne rosacea, meibomian gland dysfunction (MGD), recurrent corneal erosion (RCE) and chronic corneal wounds.2-6 Doxycycline has obvious antimicrobial properties however, the tetracycline family also exhibits a strong anti-inflammatory action when used in sub-antimicrobial concentrations. Typical Applications of Doxycycline in Eye Care Regardless, co-administration of antacids or mineral supplements still should be avoided. Doxycycline and minocycline are less affected by these substances than other tetracyclines, and administration with milk or calcium containing foods is unlikely to impair absorption substantially. Tetracycline absorption may be impaired by the concurrent ingestion of dairy products, antacids, aluminum hydroxide gels calcium, magnesium and iron or zinc salts bismuth subsalicylate (e.g., Pepto-Bismol), and dietary iron and zinc supplements. As the dosage increases, so too does the volume of unabsorbed drug.Ībsorption mostly takes place in the stomach and upper small intestine, and occurs greater in the fasting state. On an empty stomach, oral doses of doxycycline and minocycline are absorbed at rates of 95% and 100%, respectively. Both of these agents have a much better absorption profile than tetracycline, which is absorbed at a rate of 60% to 80%. 1ĭoxycycline and minocycline are the most frequently prescribed members of the tetracycline group, and are the most commonly used tetracyclines in eye care. Despite increased antimicrobial resistance, tetracyclines are still used in the treatment of Rocky Mountain spotted fever, typhus, Chlamydia, Lyme disease and several other “uncommon” conditions. The most commonly used members of this group are doxycycline and minocycline. It is important to note, however, that the rise of antimicrobial resistance has eroded the bactericidal activity of these agents–––and tetracycline in particular. Tetracyclines bind to bacterial ribosome and inhibit bacterial protein synthesis. The tetracycline group is comprised of bacteriostatic antibiotics that demonstrate activity against a wide range of aerobic and anaerobic gram-positive and gram-negative bacteria. So, in order to properly prescribe these agents, it is important to become familiar with this particular group of antibiotics. The most common systemic antibiotic that an OD is likely to prescribe is a member of the tetracycline family. But, when it comes to prescribing oral antibiotics, we often hesitate or exhibit less confidence. When treating ocular surface infections, optometrists typically feel comfortable with the use of topical antibiotics. Doxycycline is an excellent adjunctive therapy for MGD management.
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