Azasite in UK now available (Azyter)

[jlg_uk]

Hi all

I had an eye appointment with my ophth last week and they told me that Azasite is now available in the UK, and they've prescribed it. If this is old news to the board please excuse me - I don't lurk here much these days. Also I could be wrong that this is Azasite - I think it's Azithromycin dihydrate according to the patient leaflet.

I've been given 4 x 3 days worth to try 3 days each week for 4 weeks. Is this a dosage that sounds sensible? My ophth had never prescribed it before and wasn't sure.

[jlg_uk]

Should have known I would be out of date - they said it had only become available last week but obviously that's not right.

http://www.dryeyezone.com/talk/showt...able-in-the-UK

Note to self, search first.

[littlemermaid]

Not right, Moorfields Pharmacy, Azyter (may be an NHS thing).

Update and critical appraisal of the use of topical azithromycin ophthalmic 1% (AzaSite®) solution in the treatment of ocular infections, Canan Asli Utine, Clin Ophthalmol. 2011; 5: 801–809 This absolute corker of published research compares azithromycin formulations and dosages, not just Azasite, in case your ophth would like this.

Azasite has 'Durasite' base which holds it on longer, an 'aqueous mucoadhesive polymer'; Azyter has medium-chain triglycerides, which sounds nice. So in the Azasite form it has this increased staying power and thus penetration. But then we are not treating infection, are we. We are looking for antibacterial + anti-inflammatory + immunomodulatory effects.

We are trying Azyter 3 days bd, 3 days od, like you, as a pulse. Azyter is French, from Thea, so it would be good to hear what people are doing with it there for chronic bleph or dry eye.

I think, from reading here, the main problem has been stinging on a chronic dry surface. So I am going to make sure there is as much tear as possible. Not sure whether to buffer if it stings, or push on through.

It's up to your ophth to chat with UK peers and form a view RCOphth congress, Liverpool, 15-17 May 2012 . Don't expect much, do we? Look forward to hearing what you think, thanks for sharing...

Anyone else with recalcitrant mgd or chronic bleph had marked improvement on azithromycin?

How are you, jlg_uk? Did you have any improvement with cyclosporine? or better thyroid control?

[jlg_uk]

No to both those last questions unfortunately

[littlemermaid]

Is this a dosage that sounds sensible

Reading the instructions, although this is for 'purulent bacterial conjunctivitis', your 3-day pulse dose does sound sensible: 'The usual dose is... one drop in the morning, one drop in the evening. The course of treatment is three days. Azyter eye drops have a prolonged action and will continue to work after the three day course. Do not use your drops for more than three days even if you still have some residual signs of your eye infection.' (LM is currently infected so we are different again.)

OK, that stings. We even buffered 10 mins earlier with saline. OMG. Get the saline drops in stock first in case you need to flush this out, 0.9% PF Bausch & Lomb Minims. I'm looking at this advice from magoo and YuckyIsand's docs in the Azasite poll, putting it on eyelid margins only, we'll see if that works http://www.dryeyezone.com/talk/showt...hlight=azasite

jlg_uk, Do you think you are a candidate for scleral lenses? I am wondering if they are even monitoring your thyroid effectively? Have you ever been seen in Birmingham?

[jlg_uk]

No never been seen in Birmingham, have been to Moorfields once though (no help there unfortunately). Thyroid wise I take blood tests every 3 - 6 months now I'm on the right dosage (225) but after several years treatment it's not done anything for me eyes. I've also recently found out I have extra ocular muscle involvement which can be seen on an MRI I had in January - I might make a separate post about that. It does mean my troubles aren't limited to DES though (oh great).

I'll try without saline first, though from these accounts I expect pain. Can't be worse than the 2% cyclosporine drops from Moorfields though which were hell incarnate.

I've heard some people here use Azasite (US formulation) every day. Anyone know why the patient leaflet here says cannot be used more than 3 days?

[littlemermaid]

jlg_uk,

Actually, d'ya know, Azyter didn't burn at all on day 2 straight onto the eye surface, no buffer but the surface wasn't sore and dry like yesterday. Also wiped it really carefully along the eyelid margins.

I have chatted with ophths about this chronic use of topical antibacterials and derms use them like that too, not so good microbiology in terms of resistance but we have choices of antibacs, just a bit antisocial. The evolving threat of antimicrobial resistance, World Health Organisation 2012 It's also very interesting that resistant eg Staph are found in the eyes in long-term antibiotic use this way [PubMed 'antibacterial resistance eye'] so maybe we should try different ophth antibacs. So it's good we have access to azithromycin, some people report clearance on this here with Azasite like this, don't they, but maybe it depends whether it's colonised mgd or maybe it's a good immunomodulator.

The 3-day rule for Azyter is for clearing bacterial infection in normal eyes '..topical therapy with azithromycin 1.5% administered only twice daily for 3 days effectively eradicates most pathogenic bacteria associated with bacterial conjunctivitis. These microbiologic results are in accordance with the observed clinical outcome. This new anti-infective product has the advantage of a short treatment course which could lead to an improvement in patient compliance.' CHU de Limoges http://www.ncbi.nlm.nih.gov/pubmed/18988154. They're emphasising that because other antibacterials need 5 days+ for that.

We are looking for anti-inflammatory effects from long-term ophthalmic antibacterials as well, which only some have, so it's worth checking. I think if the glands are clogged, there's going to be various dermatophytes in there and we use flax/fish oil + healthy diet + warm flannel hygiene to keep the meibom moving. Also sensitive anti-dandruff shampoo for the hair as an antifungal, which is bit harsh if you've got sensitivities, alternating with a hypersensitive minimum-chemical brand with tea tree Avalon in case there's overgrowth of demodex (NB this is for an aetiology with signs of sebaceous dermatitis, but may be useful for thinking about obstructed mgd).

I am worried about allergy and increasing hypersensitivities from chemicals so I'm glad we're not using this azithromycin for long.

http://www.ncbi.nlm.nih.gov/pubmed/10928757 'Antibiotic drops placed in the conjunctival cul-de-sac appear to be as effective as ointment applied to the lid margins in reducing bacterial colonization in patients with > or =50 CFU/mL of bacteria on the lid margins.' University of Texas Health Science Centre

Another interesting point is that some antibacterials are bactericidal (kill), some bacteriostatic (maim), so our immune systems might need a boost to finish 'em off (wiki..). Eg a vet usually prescribes vitamin and mineral supplements along with topical/oral eradication for dermatophytes or infection (I'm really tempted to see a vet for this sometimes..). Have you had any sensible advice on nutrition to help thyroid imbalance?

In support of Regina's posts, this is interesting Effect of antibacterial honey on the ocular flora in tear deficiency and meibomian gland disease, Queensland UT, Brisbane. We're not putting it near the eyes because it's a child and I'm scared of botolinum toxin, but some do, but we like a spoonful of Manuka honey for a cold or sore throat (expensive, Ł16/jar for 35+). Those bees make this nutritious stuff for their grubs, who are packed in cells in a busy colony, lots of infiltrates from outside, so they know a thing or too about antibacterial and antifungal and antiparasitical agents. Fascinated that the NHS are using honey for MRSA infected wounds now. (We are using many antibacterials as topicals for acne rosacea to control infection, but we are using a honey + beeswax moisturiser which is very calming on the red inflammation and seems to help the 'skin barrier' and presumably help regulate the antimicrobial response.)

I was just wondering if Birmingham or Moorfields would come up with any new management suggestions?

[jlg_uk]

Thanks very much for that very informative post. I'm yet to check the links but a good overview nonetheless.

No - never been given any nutritional advise regarding my (hypo)thyroid condition save to take selenium from my ophth (which I do). I'm also taking fish + flax oil every day though can't say I've noticed any benefit over the years. That's not to say there hasn't been any though.

I should be getting Azyter later this week once the pharmacy has delivered. As not much has helped me over the past 3 years or so I don't expect much - but I'm more than happy to be surprised

[littlemermaid]

Just noticed there's a thyroid eye specialist in Lacrima's link to Moorfields Private and I've found it depends who you see (sometimes these guys respond kindly in the NHS to a charming email or letter). Have you found a thyroid forum? Your ophth sounds good.

[spmcc]

I just want to throw out there that I tried Azasite a couple times a few years ago (it didn't do anything for me) and the doctors told me NOT to put it directly IN my eyes but just along the lash line.

In comparison, I was told to instill vigamox (antibiotic drop) directly in my eye.

I don't know what people are being directed to do with Azyter. But I thought I'd just mention my experience with Azasite.

[littlemermaid]

Thanks, spmcc, Good point, the study looks at Azasite in the vitreous due to this increased absorption, ew (hardly any). Has anyone had good advice on Azyter?

[spmcc]

There could be a couple reasons for the differences in how I was told to use Azasite vs Vigamox...

1) viscosity - Azasite is thick. Vigamox is more like a liquid drop.

2) preservatives - Azasite has BAK (bah!). Vigamox does not.

Again, I don't know what Azyter looks like...

[littlemermaid]

I am worried about allergy and increasing hypersensitivities from chemicals so I'm glad we're not using this azithromycin for long.

Nope, no miraculous flowing meibom. That's not to say it hasn't helped because it has cleared the chalazia. Nasty looking cherry red inflammation in the lower sac though, gone now we've stopped it, eye surface looks alright. Maybe it would've been better along the eyelash line only because of the sensitivity. We are pressing on with fish oil etc.

[littlemermaid]

Actually, we've had clear meibom 4wks+ since using this azithromycin 6 days only. But we are also using steroid drops. But the meibom is still clear.

[bunnyrabbit123]

Just came from a visit with my opth. today- we happened to talk about azasite. He says that his patients have had only short term success with this med. At the start, azasite was going to be the cure for mgd. Even the drug reps have pretty much quit talking about it. I long for the day when something really works! Right now, I'm trying IPL after almost a year on restasis with limited success (another miracle cure that ain't)