Doxy for MGD

[Signe]

I have MGD and severe dry eyes. I have tried everything that is available for dry eyes (IPL, Lipiflow, Restasis, Ikervis, all kind of eye drops, Blephasteam googles and lid massage, lid hygiene, coconut oil, castor oil, omega 3, vitamins, drinking plenty of water, testosterone cream, Manuka honey drops etc etc), but I have not tried doxy yet because my stomach usually does not tolerate antibiotics at all. My glands are totally blocked and my Dr. recommends doxy for 3 months. Has anyone experienced that the effect from doxy is long term? I am worried that I will go through 3 months with plenty of side effects from the doxy and that the eventual result only is temporary. Any advice?

[Guest]

I’d do whatever your dr says. My personal protocol is to stay on 100mg twice a day as long as possible up to a year. Then taper to a lower maintenance dose of 50mg indefinitely. I am exactly like you, my stomach does very bad with antibiotics. I’d love to say I’ve had zero side effects but I can’t. My only real side effect is nausea. After a couple months on the drug, taking the pill makes me sick now for about an hour. I still think it’s wirth it. Doxy and steroids are the only two drugs that really unblocked my glands and healed my lids. So I think it’s a crucial piece of the puzzle. Nothing legitimately helped until I took doxy. So I get your apprehension, but honestly, I would do it. You have very little to lose and a lot to gain. Good luck, hope you start feeling better on the doxy.

[deep_dry_eye]

You can try Azithromycin instead, Azithromycin is usually softer on the stomach, and is more effective for MGD. It's less prescribed because there is no sub-antibiotic dosage (i.e., for doxy, the dosage prescribed usually 20-40mg vs say 150mg which is used for infections).

Topical Azithromycin is also very effective, and personally its the most effective drug I've ever used. Azyter is topical Azithromycin w/o preservatives and available in the EU and various countries in Asia. It's also super cheap as well. I recommend you giving that a try if you can get access to it. Topical Azithromycin can flush out your glands and convert your thick secretions and liquify them.

[quattroboy]

I thinking of talking to my Doc on the 12th about using something to stop my glands reblocking.

Any thoughts on minocycline, it seems to have a positive effect on the quality of the oils produced.

I've found a number of studies, one below and it seems to be more gentle on the stomach.

https://www.contactlensjournal.com/a...020-5/abstract

[deep_dry_eye]

I thinking of talking to my Doc on the 12th about using something to stop my glands reblocking.

Any thoughts on minocycline, it seems to have a positive effect on the quality of the oils produced.

I've found a number of studies, one below and it seems to be more gentle on the stomach.

https://www.contactlensjournal.com/a...020-5/abstract

minocycline and doxy belong to the same class of antibiotics, they should have similar effects. personally i still find azithromycin to be the best (ive tried doxy as well).

[mbperso]

I experienced doxy 100mg/day, 1 month out 2, for a few months => very effective on me and no side effects.
2 years ago I experienced Azyter drops and it seemed to work well.
From what I read Azithromycin pills are more effective and with no side effects

[Milo007]

minocycline and doxy belong to the same class of antibiotics, they should have similar effects. personally i still find azithromycin to be the best (ive tried doxy as well).

How many rounds of azithromycin do you think would be necessary to develop antibiotic resistance?

I don't think it's wise to use azithromycin before exhausting out other options to control inflammation.

Azithromycin is like a trump card in a dry eye patient's repertoire which should be used only if every other option fails. Also if bacterial overgrowth is the major problem one should rotate antibiotics to prevent development of a specific antibiotic resistance.

[deep_dry_eye]

How many rounds of azithromycin do you think would be necessary to develop antibiotic resistance?

I don't think it's wise to use azithromycin before exhausting out other options to control inflammation.

Azithromycin is like a trump card in a dry eye patient's repertoire which should be used only if every other option fails. Also if bacterial overgrowth is the major problem one should rotate antibiotics to prevent development of a specific antibiotic resistance.

Unknown. Acne patients (also benefit from azithromycin) have gone >3 months without any side effects problem (easy to Google these studies). The fear of antibiotic resistance isn't for yourself, but rather the herd (the general population).

I actually disagree that Azithromycin should be trump card -- why is it any more different than doxy? Azithromycin is very safe, one of the most prescribed oral antibiotics actually.

[Milo007]

I actually disagree that Azithromycin should be trump card -- why is it any more different than doxy? Azithromycin is very safe, one of the most prescribed oral antibiotics actually.

Because doxycycline has been in use for decades now and azithromycin is relatively a much newer antibiotic. Due to the abuse of doxycycline for a much longer time relative to azithromycin the majority of population today is resistant to its antibiotic action. This can be confirmed by performing an antibiotic response test using samples of urine. A popular misconception is that doxycycline works in clearing MG blockage due to it's antibiotic action. The truth is it's not the antibiotic action but the anti inflammatory action that makes the difference.

This is the reason that the standard first line protocol of treatment in MGD is oral doxycycline combined with topical azithromycin.If the antibiotic action of doxycycline was sound enough then azithromycin would not have been necessary. A study also confirmed that when doxycycline was used alone in MGD patients it didn't improve tear parameters like TBUT LLT or OSDI significantly. When azithromycin was used alone on the same group of patients it improved the tear parameters significantly due to the superior antibiotic and anti inflammatory action of azithromycin. When both were used in combination the parameters improved even further which confirms the contribution of doxycycline primarily as an anti inflammatory drug for MGD.

Secondly azithromycin has much superior antibiotic action on the staphylococcus strains of bacteria found commonly in skin and eyes in comparison to doxycycline. So it's definitely not worthwhile to risk the development of resistance to a much superior grade of antibiotic. In this context it is undoubtedly different from doxycycline.

I didn't say azithromycin wasn't safe but I am personally more careful with its use. My doctor refused to prescribe me azithromycin the second time even on my request as she was "saving" it for potential future use.

Unknown. Acne patients (also benefit from azithromycin) have gone >3 months without any side effects problem (easy to Google these studies). The fear of antibiotic resistance isn't for yourself, but rather the herd (the general population).

Again the fact that acne patients have gone >3 months without any SIDE EFFECTS doesn't eliminate the problem of antibiotic resistance. Absence of side effects is just a measure of the safety of the drug. And it's not "unknown" as you write regarding the number of times azithromycin can be used before pathogens develop resistance. Azithromycin becomes less effective after just 5 rounds of administration and is almost ineffective after 7-8 rounds of its use. These are the words coming from my opthalmologist.

[MGD1701]

azithromycin
I have read a few reports from professional journals that this is effective and less side-effect as doxy.
I am sure you can easily obtain such info.

However, since you have tried many, maybe there are other issues,
capping, biolfim - then BlephEx etc should help
scar tissue - then probing should help
allergy, demodex (need tea tree oil) etc.

[Signe]

Thank you for the answers. I will do some research on Azithromycin and ask my dr. about it.

[MGD1701]

Hi Signe
Wise to find out if gland/lashe ducts/orifices are covered by scar tissue or capped, or (years of sticky bacterial) biofilm issue as these needed to be solved first - otherwise doxy might not be effective since you have tried LipiFlow, IPL. Right order does make a big difference. More please read my old post

http://forum.dryeyezone.com/forum/ar...a-tea-tree-oil

[Guest]

Because doxycycline has been in use for decades now and azithromycin is relatively a much newer antibiotic. Due to the abuse of doxycycline for a much longer time relative to azithromycin the majority of population today is resistant to its antibiotic action. This can be confirmed by performing an antibiotic response test using samples of urine. A popular misconception is that doxycycline works in clearing MG blockage due to it's antibiotic action. The truth is it's not the antibiotic action but the anti inflammatory action that makes the difference.

This is the reason that the standard first line protocol of treatment in MGD is oral doxycycline combined with topical azithromycin.If the antibiotic action of doxycycline was sound enough then azithromycin would not have been necessary. A study also confirmed that when doxycycline was used alone in MGD patients it didn't improve tear parameters like TBUT LLT or OSDI significantly. When azithromycin was used alone on the same group of patients it improved the tear parameters significantly due to the superior antibiotic and anti inflammatory action of azithromycin. When both were used in combination the parameters improved even further which confirms the contribution of doxycycline primarily as an anti inflammatory drug for MGD.

Secondly azithromycin has much superior antibiotic action on the staphylococcus strains of bacteria found commonly in skin and eyes in comparison to doxycycline. So it's definitely not worthwhile to risk the development of resistance to a much superior grade of antibiotic. In this context it is undoubtedly different from doxycycline.

I didn't say azithromycin wasn't safe but I am personally more careful with its use. My doctor refused to prescribe me azithromycin the second time even on my request as she was "saving" it for potential future use.



Again the fact that acne patients have gone >3 months without any SIDE EFFECTS doesn't eliminate the problem of antibiotic resistance. Absence of side effects is just a measure of the safety of the drug. And it's not "unknown" as you write regarding the number of times azithromycin can be used before pathogens develop resistance. Azithromycin becomes less effective after just 5 rounds of administration and is almost ineffective after 7-8 rounds of its use. These are the words coming from my opthalmologist.

Thank you for writing this, couldn’t agree more. Well said. I didn’t understand that difference between the two drugs.

[Milo007]

Thank you for writing this, couldn’t agree more. Well said. I didn’t understand that difference between the two drugs.

You are welcome!

Any idea why smileys don't work in this platform?

[Guest]

You are welcome!

Any idea why smileys don't work in this platform?

No clue on the emojis, but appreciate your insight. Hard to find people with a solid understanding of biology.