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Azithromycin ophthalmic solution 1% (AzaSite, Inspire Pharmaceuticals), a broad-spectrum antibiotic that has the propensity to penetrate into the ocular tissues, rapidly improves anterior blepharitis faster than any other treatments for blepharitis, according to one ophthalmologist.
"This allows us to get patients with blepharitis ready for cataract surgery or laser vision correction in a timely fashion," Dr. Gayton said.
"Blepharitis is a very common chronic condition that can be difficult to improve using traditional therapy," he continued. "Because of its unique characteristics, including its ability to penetrate the ocular tissues, azithromycin acts rapidly to improve blepharitis in my patients."
He discussed a rabbit study conducted by Francis Mah, MD, and colleagues, in which the investigators found high levels of azithromycin present days after the course of therapy was completed.
In another study conducted by Jodi Luchs, MD, and associates, one group of patients with blepharitis was treated with azithromycin and compresses, whereas a second group was treated with warm compresses alone. The researchers reported a marked improvement in the patients with blepharitis treated with azithromycin compared with the second group.
One step further
Dr. Gayton said he was impressed with those results, but he took his study one step further to demonstrate the clinical effects of azithromycin. He treated his group of patients who had blepharitis (n = 10) with azithromycin (1 drop in both eyes at bedtime) and documented their progress with photographs taken before and then 2 weeks after the treatment was initiated. He described the difference between the two time points as "dramatic."
The anti-inflammatory effect is beneficial in treating blepharitis for patients with the condition who frequently have inflammation of the ocular surface and lid tissues, Dr. Gayton said.
Another benefit is that the vehicle, a combination of polycarbophil, edentate disodium, and sodium chloride, is viscous, increasing the amount of time that the eye is exposed to the drug. Importantly, the dosing regimen is less demanding than other topical antibiotics, which can require instillation of drops up to four times a day, he said. The typical patient with blepharitis may instill azithromycin drops twice daily (2 drops the first 2 treatment days) and then 1 drop each day until the condition is under control. Dr. Gayton, however, said that he simply starts patients on 1 drop a day at bedtime.
Preop treatment regimen
He said he considers azithromycin an important component in his preoperative treatment regimens. For patients with ocular surface disease undergoing surface ablation, Dr. Gayton treats them with azithromycin for 2 weeks before the surgery because this patient group is particularly at risk for Staphylococcus infections. Patients who are considered low risk for laser vision correction are advised to start the medication 5 days preoperatively. Patients with blepharitis preparing to undergo cataract surgery also instill the drops starting 14 days preoperatively.
"Azithromycin is a great drug," Dr. Gayton concluded. "It works fast, which is the most important benefit for patients with blepharitis. It decreases colony counts and improves the patient's tear film."