Topical Azithromycin Research Articles

Management of Busulfan-Induced Lung Injury in Pediatric Patients with High-Risk Neuroblastoma

Background/Objectives: Integrating the cytotoxic drug busulfan into a high-dose chemotherapy regimen prior to autologous hematopoietic stem cell rescue in patients with high-risk neuroblastoma has improved the survival of children battling this deadly disease. Busulfan-induced toxicities can, however, be severe. Here, we describe the diagnosis and successful treatment of acute pulmonary injury by total-body-weight-adjusted busulfan therapy in two children with high-risk neuroblastoma. Case series: Patient 1 developed life-threatening biphasic acute respiratory failure on days +60 and +100 after busulfan therapy, requiring intubation and invasive mechanical ventilation. Despite intensive anti-inflammatory and immunomodulatory therapy, including systemic corticosteroids, topical inhalation regimens, azithromycin, nintedanib and extracorporal photopheresis, patient 1 required extended intensive care measures and non-invasive respiratory support for a total of 20 months. High-resolution computed tomography showed diffuse intra-alveolar and interstitial patterns. Patient 2 developed partial respiratory failure with insufficient oxygen saturation and dyspnea on day +52 after busulfan therapy. Symptoms were resolved after 6 months of systemic corticosteroids, topical inhalation regimens and azithromycin. High-resolution computed tomography showed atypical pneumonic changes with ground-glass opacities. While both patients fully recovered without evidence of pulmonary fibrosis, cancer therapy had to be paused and then modified until full recovery from busulfan-induced lung injury. Conclusions: Busulfan-induced lung injury requires prompt diagnosis and intervention. Symptoms and signs are nonspecific and difficult to differentiate from other causes. Therapeutic busulfan drug level monitoring and the identification of patients at risk for drug overdosing through promoter polymorphisms in the glutathione S-transferase alpha 1 gene encoding the main enzyme in busulfan metabolism are expected to reduce the risk of busulfan-induced toxicities.

Long-Term Prognosis of Anterior Blepharitis After Topical Antibiotics Treatment.

We conducted a retrospective evaluation of the long-term prognosis associated with anterior blepharitis subsequent to topical antibiotic intervention. Inclusion criteria encompassed 92 eyes of 92 patients who exhibited clinical manifestations of anterior blepharitis and undergone a regimen of topical azithromycin. The follow-up duration extended to a minimum of one year within our medical facility. The diagnostic framework for anterior blepharitis, along with the evaluation of both objective and subjective manifestations, adhered to the Blepharitis Preferred Practice Pattern as promulgated by the American Academy of Ophthalmology. Relapse denoted the resurgence of blepharitis symptoms subsequent to the primary treatment, necessitating the instigation of either topical or oral therapeutic measures. Of 92 cases of anterior blepharitis, 48 showed recurrence, with a recurrence rate of 52.2%. During the follow-up period, 2 patients experienced 5 relapses, 2 patients experienced 4 relapses, 5 patients experienced 3 relapses, 13 patients experienced 2 relapses, and 26 patients experienced 1 relapse. When the patients were divided into three groups: multiple recurrence group (22 patients), single recurrence group (26 patients), and no recurrence group (44 patients), there were no significant differences in the blepharitis finding score before and after the initial treatment among three groups. However, significantly fewer patients in the no recurrence group required further treatment after initial treatment, and the percentage of patients with residual blepharitis during follow-up was significantly lower in the no recurrence group. Our data suggest that patients with residual findings after blepharitis treatment are at a risk of recurrence.

Increased risk of pigmentary degeneration of the iris and pigmentary glaucoma with fluoroquinolone antibiotics.

Fluoroquinolones are popular antibiotics used for a myriad of conditions including ocular procedures. Despite numerous case reports of acute pigmentary degeneration of the iris with fluoroquinolone use, a pharmacoepidemiological study has not been performed to examine and quantify this risk. Retrospective cohort study with a case-control analysis. A cohort of 1,231,881 new users of oral or topical moxifloxacin, levofloxacin, and azithromycin were followed to first diagnosis of pigmentary degeneration of the iris or pigmentary glaucoma. Four controls were selected for each case using density sampling, matching on age and calendar time. Users of oral or topical moxifloxacin were compared to levofloxacin and azithromycin, a negative control drug from a separate class. First incidence of pigmentary degeneration of the iris or pigmentary glaucoma. The cohort was comprised of 1,231,881 new users of topical or oral levofloxacin, moxifloxacin, or azithromycin. 542 cases of pigmentary degeneration of the iris and 460 cases of pigmentary glaucoma were identified. The incidence of iris pigmentary degeneration or pigmentary glaucoma for topical moxifloxacin was 10.2/1000 person years compared to 2.6/1000 person years for topical azithromycin. Current topical moxifloxacin users had the highest adjusted IRR for pigmentary degeneration of the iris (IRR = 6.81, [95%CI:2.00-23.18]) and pigmentary glaucoma (IRR = 4.07 [95%CI:1.42-11.62]) respectively. The study findings suggest that patients using topical moxifloxacin may have increased risk of developing pigmentary degeneration of the iris and pigmentary glaucoma although the absolute increase was low. Future studies are needed to confirm this association.

Efficacy and safety of topical azithromycin therapy in patients with blepharitis and meibomian gland dysfunction

PurposeTo assess the effects of 1% azithromycin ophthalmic solution (AZM) in patients with bacterial blepharitis accompanied by meibomian gland dysfunction (MGD).Study designA multicenter, single arm, prospective interventional study.MethodsAZM was administered to the affected eyes twice daily for the first 2 days and once daily for the subsequent 12 days. Lid margin hyperaemia/redness, collarette at the root of the eyelashes, conjunctival hyperaemia, foreign body sensation, and epiphora were assessed on Days 1, 14, and 28. The Dry Eye-related Quality of Life Score (DEQS) and objectives related to MGD, including lid vascularity, lid margin irregularity, foaming, lid plugging, keratoconjunctival disorders, Marx line, meibum grade, and tear breakup time, were also assessed. Bacterial culture of the conjunctival sac and meibum was performed on Days 1 and 14.ResultsTwenty-four eyes of 24 patients (10 men/14 women, mean age 72.3 ± 13.2) were included. On Days 14 and 28, the total score, lid vascularity, lid plugging, and meibum grade showed significant improvement (p < 0.05). On Day 1, 71 strains were isolated from 22 of the 24 eyes (91.7%). Cutibacterium acnes, Corynebacterium spp., and Staphylococci were detected at high frequencies. The overall disappearance rates of the bacteria in the conjunctival sac and meibum at the end of treatment were 65.7% and 58.3%, respectively. No serious ocular or systemic adverse events were observed.ConclusionFourteen-day treatment with AZM was effective in patients with blepharitis accompanied by MGD, and the efficacy of AZM persisted for a period after the treatment.

The topical azithromycin meibomian gland dysfunction survey: The effect of topical azithromycin on signs and symptoms of meibomian gland dysfunction.

The aim of this study was to assess the long-term effects of topical azithromycin on signs, symptoms and self-management of meibomian gland dysfunction (MGD). Forty participants were assessed for MGD and its effect on the fluorescein tear break-up time (FTBUT). Participants were treated with topical azithromycin twice daily for 2 weeks and then once daily for a further 2 weeks. One year after treatment, 31 participants completed a survey assessing pre- and post-treatment effect on symptoms, lifestyle and self-treatment methods. Following treatment, there was a significant reduction in MGD grading from a median of grade 2 to grade 0 (z = 4.40, p < 0.0001) and an increase in FTBUT from a median of 3-8 s (z = 4.75, p < 0.0001). One year afterwards, the survey showed a significant improvement in symptoms (sensitivity to light, grittiness, burning, blurred vision, all p < 0.03) and reduction in required self-treatments (lid wipes, tear substitutes, both p < 0.03). There was also a reduced impact on lifestyle (reading, night driving, computer use and watching television, all p < 0.0001) and in all environmental conditions (all p < 0.0001). This study confirms the positive effect of topical azithromycin on MGD and shows it has a long-term impact on symptoms, self-treatment methods and lifestyle. This has implications for both chair time and healthcare costs when managing patients with MGD. Pending further clinical trials in a larger population with different demographics, topical azithromycin should be considered by all eyecare practitioners as a viable pharmacological treatment when managing MGD.

Improvement of Clinical Findings, Meibography and Tear Film Parameters in Pediatric Ocular Rosacea Patients After a Standard Treatment Protocol

ABSTRACT Purpose The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. Methods The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). Results The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3–18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). Conclusion This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches.

Effect of Treatment with Topical Azithromycin or Oral Doxycycline on Tear Film Thickness in Patients with Meibomian Gland Dysfunction: A Randomized Controlled Trial.

Purpose: This prospective, randomized, observer-masked, parallel-group study aimed to compare the effect of topical azithromycin and oral doxycycline on tear film thickness (TFT) and signs and symptoms of ocular surface disease (OSD) in patients with meibomian gland dysfunction (MGD). Methods: Patients were randomized to either receive topical azithromycin or oral doxycycline. After a baseline visit, three follow-up visits at intervals of 2 weeks were scheduled. Main outcome of the study was change in TFT as measured with ultrahigh resolution optical coherence tomography. Results: Twenty patients were included in the analysis. TFT significantly increased in both groups (P = 0.028 vs. baseline) with no difference between the groups (P = 0.096). As secondary outcomes, ocular surface disease index (OSDI) score and composite signs of OSD significantly decreased in both groups (P = 0.023 for OSDI and P = 0.016 for OSD signs vs. baseline). While eye-related adverse events (AEs) occurred more frequently in the azithromycin group, systemic AEs were more common in the doxycycline group. Conclusions: Both treatments improved signs and symptoms of OSD in patients with MGD with no difference between the groups. Due to the higher frequency of systemic side effects of doxycycline, azithromycin eye drops seem to be an alternative with comparable efficacy. Clinical Trial Registration number: NCT03162497.

Liposomes containing azithromycin and green tea as an anti-acne treatment: Formulation and Characterization

Liposomes and other novel drug delivery carriers are highly adaptable, allowing for the distribution of a wide range of pharmacological compounds. The antibiotic azithromycin is widely regarded as the most effective treatment for acne. Lower efficacy or higher negative effects have led to decreased use of topical azithromycin. In this study, liposomes have been chosen because it is hypothesised that this may lessen the drug's side effects when used in conjunction with Azithromycin. Traditional herbal therapies have been intensively investigated as alternatives to conventional treatments for many ailments due to the possibility for side effects and antibiotic resistance from conventional pharmaceuticals. Thanks to its antibacterial qualities, green tea is one of the most effective natural therapies for acne. The lipid film hydration method was used to create drug-loaded liposomes, and the optimal component ratios were established. Liposomes were studied for their in-vitro drug release properties and characterised for their vesicle size, shape, encapsulation effectiveness, and drug content. Formulations F1 and F6, which included a 1:1 ratio of fat to cholesterol, showed the highest levels of encapsulation efficiency (69.5% and 66.2%, respectively) and in-vitro drug release (82.5 and 82.2 percent, respectively). Carbopol gel has been modified to include liposomal formulations, and the results have been compared to those of commercially available gels that do not use liposomes. Within 24 hours, the release of azithromycin (90.5%) was greater in the non liposomal marketed gel than in the liposomal gel (77.5% and 74.8%) of green tea. Green tea liposomes used in the formulation had a MIC value that was comparable to that of commercially available, non-liposomal gel. It was discovered that azithromycin was more effective than green tea in killing Micrococcus luteus.

Clinical features of anterior blepharitis after cataract surgery

We evaluated the clinical features of postoperative anterior blepharitis following cataract surgery and the efficacy of topical azithromycin retrospectively. Thirty eyes of 30 patients with a clinical diagnosis of anterior blepharitis by 6 months postoperatively among those who underwent cataract surgery at our institution between November 2020 and June 2022 were included. The diagnosis of anterior blepharitis and the assessment of objective and subjective findings were based on the American Academy of Ophthalmology Blepharitis Preferred Practice Pattern®. Azithromycin eye drops were prescribed for all patients, and findings and symptoms before and after the drops were reviewed. The time of onset ranged from 2 weeks to 6 months after cataract surgery, with the most common onset at 2 to 3 months postoperatively (mean time of onset 79.4 ± 39.6 days). The type of anterior blepharitis was staphylococcal blepharitis in 26 eyes and seborrheic blepharitis in 4 eyes, while mixed type with posterior blepharitis was noted in 6 eyes. Symptoms at the time of examination included irritation (including foreign body sensation) in 24 eyes, tearing in 4 eyes, and redness in 3 eyes. The findings and symptoms of anterior blepharitis were alleviated or resolved with azithromycin eye drops in 26 of the 30 eyes, but the blepharitis recurred in 6 of these eyes, requiring azithromycin eye drops to be re-prescribed. The onset of anterior blepharitis after cataract surgery may be related to a gradual decrease in postoperative eye drops. Patients tended to complain of irritation and foreign body sensation, and azithromycin eye drops were effective in such cases.

Comparison of therapeutic effects of topical azithromycin versus topical azithromycin with systemic doxycycline on posterior blepharitis

Purpose The aim of this study was to compare the therapeutic effects of topical azithromycin versus topical azithromycin with systemic doxycycline on posterior blepharitis. Patients and methods This is a prospective comparative study that was performed on 80 eyes of 40 patients with posterior blepharitis. The patients were divided into two groups: group A included the patients who received a 1-week topical azithromycin 1.5% solution twice a day, followed by another 1-week topical azithromycin 1.5% solution once daily, while group B included the patients who received the same regimen with additional oral doxycycline 100 mg once a day for 3 weeks. All patients were examined by the slit lamp for lid collarettes, lid redness, plugging of meibomian gland orifices, and tear breakup time after 1 week, 1 month, and 3 months. Results Before treatment, there were no statistically significant difference between the two groups regarding the symptoms and signs. After treatment, all symptom and sign scores were decreased compared with the baseline scores. Group B patients significantly improved more than group A patients after 1 month (P=0.002) and after 3 months (P=0.001) regarding the symptoms and most of the signs [lid collarettes after 1 month (P=0.013), lid redness after 1 month (P=0.009), and after 3 months (P=0.002), plugging of meibomian gland orifices after 1 month (P=0.001) and after 3 months (P&gt;0.001), tear breakup time after 1 month (P=0.001) and after 3 months (P=0.004), and corneal staining after 1 month (P=0.001) and after 3 months (P&gt;0.001)]. Only concerning lid collarettes, the difference in improvement between the two groups was insignificant after 3 months (P=0.177). Conclusion Adding systemic doxycycline with topical azithromycin to the management plan of posterior blepharitis were found to be more superior than using topical azithromycin alone.

Erlotinib-induced dry eye.

Erlotinib is a newer, second-line oral antineoplastic drug mainly used in the treatment of non-small cell lung carcinoma, in addition to carcinomas of the pancreas, esophagus, and ovaries.[1] It targets protein tyrosine kinase and inhibits phosphorylation of epidermal growth factor receptor (EGFR), thereby blocking tumor cell proliferation. Other previously reported ocular side effects of erlotinib include trichomegaly, periorbital inflammation, ectropion, and epiphora.[2–4] Case Report A 58-year-old female presented with complaints of persistent irritation and redness in both eyes since a month. She was diagnosed with adenocarcinoma of the lung and had been under treatment with oral EGFR antagonist erlotinib for 6 months. Ocular examination revealed sparse eyelashes, blepharitis, and diffuse conjunctival congestion in both eyes [Fig. 1a]. Fluorescein staining showed punctate epithelial erosions and a tear film breakup time of 9 s [Fig. 1b]. She was diagnosed with erlotinib-induced blepharitis and dry eye; she was started on treatment with topical azithromycin ointment and preservative-free lubricants and was advised lid hygiene and hot fomentation as supportive therapy. Discontinuation of erlotinib was not advised as the tumor was responsive to the therapy and the side effects were tolerable and improved with treatment.Figure 1: (a) Diffuse slit-lamp image showing sparse eyelashes and blepharitis with decreased tear film height. (b) Diffuse slit-lamp image with cobalt blue filter showing punctate epithelial erosions on corneaEGFR receptors are found in the sebaceous glands, hair follicles, capillary system, and basal epidermal cells, and the abundance of these in the periorbital region has been hypothesized to be the reason for the ocular side effects of erlotinib.[2,4] A murine study with topical erlotinib showed it to cause a reduction in goblet cell numbers, ultrastructural changes to the corneal epithelium, and a significant reduction in the tear film breakup time.[5] With foreseeable increase in the use of erlotinib in cancer therapy, it is essential to understand its ocular side effects for appropriate patient education and treatment, which may warrant a concerted management from the ophthalmologist and the oncologist. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Randomized Double-Masked Placebo-Controlled Trial for the Management of Pythium Keratitis: Combination of Antibiotics Versus Monotherapy.

The aim of this study was to compare the efficacy of monotherapy (topical linezolid 0.2%) versus a combination of antibiotics (topical linezolid 0.2% and topical azithromycin 1%) for the treatment of Pythium insidiosum keratitis. Cases of P. insidiosum keratitis were prospectively randomized into group A on topical 0.2% linezolid along with topical placebo (sodium carboxymethyl cellulose [CMC] 0.5%) and group B on a combination of topical 0.2% linezolid and topical 1% azithromycin. Both groups were compared by proportion of both clinical resolution and worsening of keratitis along with the number of therapeutic penetrating keratoplasty (TPK) performed at 3 months. We initially planned N = 66 patients but later limited to 20 (N = 10 in each group) patients owing to one interim analysis. The average size of the infiltrate in group A and B was 5.6 ± 1.5 mm and 4.8 ± 2.0 mm, respectively, with a mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity of 2.74 ± 0.55 and 1.79 ± 1.19. At 3 months, from group A, 7 (70%) patients needed TPK and 2 patients had signs of resolution, whereas from group B, 6 (60%) patients achieved complete resolution (P = 0.0003) and 2 were improving while only 1 needed TPK (P = 0.02). The median duration of treatment in group A and B, with the study drugs, was 31 days (17.8-47.8) and 101.5 days (80-123.3), P value = 0.003, respectively. Final visual acuity at 3 months was 2.50 ± 0.81 and 0.75 ± 0.87, P = 0.02, respectively. A combination of topical linezolid and topical azithromycin was found to have superior efficacy than the monotherapy with topical linezolid for the management of Pythium keratitis.

Efficacy of Topical Azithromycin versus Systemic Doxycycline in Treatment of Meibomian Gland Dysfunction.

Ocular surface disease (OSD) is a multifactorial and highly frequent problem. Inadequate or unstable tear film is the main cause, which leads to visual impairments. One of the primary causes of OSD is meibomian gland dysfunction (MGD), with a prevalence of 3.5 to 70%. The aim of this work was to compare the efficacy of azithromycin topical eye drops versus oral doxycycline in MGD individuals. This prospective comparative cohort research was carried out on 56 patients of both sexes of any age with symptomatic MGD. Randomly, patients were classified into two equal groups: Group 1 was treated twice daily for 4 weeks with topical azithromycin 1% eye drops, while group 2 received oral doxycycline 100 mg capsules twice daily for 4 weeks. In the 1st follow-up, there was a significant difference between the studied groups in pain and discomfort degree (P value = 0.024) as group 1 showed a higher number of patients with a mild pain degree (P value = 0.013) while group 2 showed a higher number of patients with a severe pain degree (P value = 0.022). There was an insignificant difference between the studied groups in moderate pain degree and lid margin telangiectasia. Conjunctivitis, frothy discharge, and meniscus floaters were significantly higher in group 2 than in group 1 (P value = 0.013, 0.028, and 0.031, respectively). In group 1, the break-up time test was significantly higher than in group 2 (P value = 0.023). In the 2nd follow up, in group 2 only meniscus floaters were significantly higher than in group 1 (P value = 0.044), while in group 1 break-up time test was significantly higher than in group 2 (P value = 0.029). Otherwise, there is no significant difference between both the groups. Meibomian gland dysfunction (MGD) could be treated effectively with oral doxycycline and topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Moreover, the topical azithromycin group seemed to be superior over the oral doxycycline group in improving the quality of tear film in the short term, having fewer side effects, more compliance, and better tolerability.

Paediatric ocular rosacea: diagnosis and management with an eyelid-warming device and topical azithromycin 1.5%

Ocular rosacea is a chronic inflammatory disorder with periods of exacerbation and remission, often underdiagnosed in children. When diagnosed, its management is challenging because of a lack of effective long-term treatment options. To report our experience in cases of pediatric ocular rosacea treated with moist heat therapy and topical azithromycin 1.5%. The medical records of six children diagnosed with ocular rosacea based on a careful medical history and slit-lamp examination of the eyelids and ocular surface were reviewed. Previous treatments were discontinued, and children/parents were instructed to use the eyelid-warming device for 1 or 2 sessions of 10minutes each day, followed by eyelid massage and cleansing, in combination with azithromycin 1.5% eye drops. The diagnosis of ocular rosacea in these children was delayed for several months or years from the first identifiable clinical sign or symptom. All the children presented with corneal sequelae and decreased vision. Ocular manifestations included meibomian gland disease, recurrent chalazia, and phlyctenular keratoconjunctivitis. Cutaneous signs were not always associated with the condition. Ocular rosacea was usually resistant to initial treatments with antibiotics and topical corticosteroids. Treatment with the eyelid-warming device in combination with azithromycin 1.5% led to a rapid improvement in the clinical signs and was well tolerated by all patients. Childhood ocular rosacea is potentially sight threatening. Practitioners should consider this condition in order to minimise diagnostic delay and subsequent complications. Combined therapy of eyelid hygiene (including an eyelid warming device) and azithromycin 1.5% eye drops was effective in treating ocular rosacea in children.

Successful management of a unilateral persistent epithelial defect secondary to meibomian gland dysfunction in an Irish Sports Horse using a multi‐modal treatment plan

AbstractA novel equine multi‐modal protocol was implemented for management of unilateral equine dry eye disease and worsening persistent epithelial defects in a clinically well Irish Sports Horse. Utilising knowledge directly from human ophthalmic medicine for meibomian gland dysfunction, the meibomian glands were first mechanically debrided and expressed. Then a four‐point treatment protocol was instigated. The protocol comprised hot compressing, artificial tears, autologous serum and a topical azithromycin regimen, resulting in a significant improvement in persistent epithelial defects and clinical signs. This case highlights the benefits of a treatment plan containing both non‐pharmacological and pharmacological therapies targeting the lipid component of the tear film matrix in horses with dry eye disease.

Disseminated Herpes Zoster in Elderly with Human Immunodeficiency Virus (HIV) Infection: A Case Report

Background: Disseminated herpes zoster (HZ) is one of the complications of HZ in the form of the appearance of the main lesion accompanied by the spread of solitary vesicles on the body. This condition occurs in 2% of the general population and 15-30% of immunodeficient patients, such as the elderly and HIV infection.&#x0D; Case presentation: A 64-year-old man came with the complaint of rashes all over his body four days ago. Vesicles and erosions are multiple in 1 dermatome and are discrete and scattered throughout the body on dermatological examination. The diagnosis of disseminated HZ, in this case, was established based on history, physical examination, and Tzank examination. HZ spread is less common and is characterized by the appearance of more than 20 vesicles or more than 2 consecutive dermatomes. Old age and HIV infection are immunocompromised conditions causing reactivation of the varicella-zoster virus and other infections. The patient received oral acyclovir, vitamins B1, B6, and B12, salicylic powder and topical fusidic acid, antiretrovirals (ARVs), azithromycin, intraoral cotrimoxazole, ceftriaxone, and intravenous fluconazole for 10 days. Skin lesions improved in 10 days without complications.&#x0D; Conclusion: Disseminated HZ in HIV patients should be considered because of complications, recurrence, more difficult with a treat, and a higher risk of acyclovir resistance.

COMPARISON OF EFFICACY OF 1-WEEK ORAL AZITHROMYCIN WITH 2-WEEK TOPICAL 1% AZITHROMYCIN EYE DROPS IN THE TREATMENT OF POSTERIOR BLEPHARITIS

Objective: To assess the efficacy of 1-week of oral azithromycin (AM) with 2 weeks of topical azithromycin eye drops in posterior blepharitis patients. Methodology: In this quasi-experimental study, 80 participants were enrolled (&gt;45 years old) with meibomian gland dysfunction (MGD) at the Department of Ophthalmology, Qazi Hussain Ahmed Medical Complex, Nowshera from January to September 2020. Patients were allocated to get either 1-week of oral azithromycin (500mg/day) or 2 weeks of continued topical azithromycin 1% once daily. A scoring system was devised which included 5 symptoms and 7 signs which were assessed at baseline and follow-ups on 1st, 2nd, and 4th-week post-therapy. The total score was documented at the end of the study by summing up the symptoms and signs score. Results: The objective and subjective features of the disease showed improvement with either therapy, however, 2 weeks of topical azithromycin 1% once a day showed significantly more improvements (p= 0.008). We observed improvement in the symptoms of disease in both groups but that didn’t achieve the level of statistical significance between the groups (0.242). Systemic side effects in the form of anorexia, nausea, and gastrointestinal upsets were negligible in topical Azithromycin as compared to its oral form. Conclusion: Both oral and topical forms of drugs effectively ameliorated the symptoms of posterior blepharitis, however, 2 weeks of topical azithromycin 1% once a day also addressed the signs of the disease along with benefits of having better tolerance (least gastrointestinal upsets) leading to improved compliance in comparison to its oral form.

A Review of Systemic Minocycline Side Effects and Topical Minocycline as a Safer Alternative for Treating Acne and Rosacea.

Resistance of Cutibacterium acnes to topical antibiotics historically used to treat acne (topical erythromycin and clindamycin and, more recently, topical azithromycin and clarithromycin) has been steadily increasing and new topical antibiotics are needed. Minocycline is a semisynthetic tetracycline-derived antibiotic currently used systemically to treat a wide range of infections caused by Gram-negative and Gram-positive bacteria. In addition to its antibiotic activity, minocycline possesses anti-inflammatory properties, such as the downregulation of proinflammatory cytokine production, suppression of neutrophil chemotaxis, activation of superoxide dismutase, and inhibition of phagocytosis, among others. These characteristics make minocycline a valuable agent for treatment of dermatological diseases such as acne vulgaris and papulopustular rosacea. However, more frequent or serious adverse effects have been observed upon the systemic administration of minocycline than with other tetracyclines. Examples of serious adverse effects include hypersensitivity syndrome reaction, drug-induced lupus, idiopathic intracranial hypertension, and other autoimmune syndromes that may cause death. Here, we review adverse effects and drug–drug interactions observed with oral administration of minocycline and contrast this with topical minocycline formulations recently approved or under development for effectively treating dermatological disorders with fewer adverse effects and less drug interaction.

Overcoming bacteriophage insensitivity in Staphylococcus aureus using clindamycin and azithromycinat subinhibitory concentrations.

Staphylococcus aureus is a pathogen of major concern in both acute infections and chronic conditions such as chronic rhinosinusitis (CRS). Bacteriophage (phage) therapy has recently regained interest for its potential to treat infections caused by antibiotic resistant strains including Methicillin Resistant Staphylococcus aureus (MRSA). However, bacteria can adapt and become resistant to phages. The aim of this study is to determine the potential for antibiotics to overcome phage resistance. The susceptibility of S.aureus clinical isolates (CIs) to phages J-Sa36, Sa83 and Sa87 alone or in combination with protein synthesis inhibitor (PSI) antibiotics clindamycin, azithromycin and erythromycin was assessed using plaque spot assays, minimum inhibitory concentration (MIC) assays, double layer spot assays and resazurin assays. The safety and efficacy of subinhibitory PSI antibiotics in combination with phage was tested in a Sprague Dawley rat model of sinusitis infected with a phage resistant S.aureus CI. All three antibiotics at subinhibitory concentrations showed synergy when combined with all 3 phages against S.aureus CIs in planktonic and biofilm form and could sensitize phage-resistant S.aureus to promote phage infection. The combination of topical subinhibitory clindamycin or azithromycin and phage was safe and could eradicate S.aureus sinonasal biofilms in vivo. Subinhibitory concentrations of PSI antibiotics could sensitize phage-resistantS.aureus and MRSA strains to phages in vitro and in vivo. This data supports the potential use of phage-PSI antibiotic combination therapies, in particular for difficult-to-treat infections with phage-resistant S.aureus and MRSA strains.

Effect of Adjunctive Topical Liposomal Azithromycin on Systemic Azithromycin on Old World Cutaneous Leishmaniasis: A Pilot Clinical Study.

The treatment of Cutaneous Leishmaniasis (CL) is complex, and the search for safer, more efficient, and cost-effective treatments is ongoing. This study aimed to evaluate the efficacy of the combination of liposomal and oral azithromycin as the first clinical study against CL. This assessor-blind, randomized clinical trial was conducted in out-patients Leishmaniasis clinic of Skin Diseases and Leishmaniasis. The cutaneous lesions of eligible participants were randomized to receive either oral azithromycin or the combined oral and topical liposomal azithromycin. All participants received 250 mg of azithromycin twice daily or 8 mg/per kg for 4 weeks. In the combination group, a topical liposomal formulation of 0.04 mmol/mL of azithromycin was administered as 0.2-0.5 cc twice daily according to the lesion size in order to make a thin layer of the drug on the surface of the lesion. The size and induration changes from baseline to the end of the study were analyzed. Twenty-one lesions of 13 patients in the combination group and 20 lesions of 14 patients in the oral group were recruited. The mean ± SD of improvement was significantly different between two groups after 12 weeks (3.89 ± 0.46 vs. 3.15 ± 1.23 P = 0.02 combination group vs. oral group respectively). The patients did not experience any systemic adverse effects related to azithromycin and the only adverse effects related to topical treatment were mild pruritus in 2 cases. In conclusion, the combination of oral and topical liposomal formulation of azithromycin is safe and effective to treat CL.