An eye for azithromycin: review of the literature

Abstract

Azithromycin is used widely in clinical practice and recently it is available in topical solution for ophthalmic use. The purpose of the current publication is to summarize the newest information on azithromycin’s clinical usefulness over ocular diseases. A PubMed (National Library of Medicine) and a ScienceDirect search was conducted using the key phrases ‘azithromycin’, ‘meibomian’, ‘blepharitis’, ‘trachoma’, ‘toxoplasmosis’ from 2010 to 2017. Articles were limited to articles published in English or at least having an English abstract. There were no restrictions on age, ethnicity, or geographic locations of patients. Topical azithromycin was found effective and safe in various ocular surface infections, in meibomian gland dysfunction and in trachoma. Also, it may substitute fluoroquinolones in corneal UV cross-linking. The World Health Organization targets for trachoma elimination are being reached only after 3 years of annual mass drug administration. Oral azithromycin can participate in combination regiments for toxoplasmosis, mainly because of its very good safety profile and may play a significant role in toxoplasmosis in pregnancy. Azithromycin is one of the safest antibiotics, well tolerated, and with special pharmacokinetic properties. Also, it is characterized by a broad antimicrobial spectrum. Azithromycin is efficacious for the treatment of a lot of ocular diseases and may be included as monotherapy or in combination therapy in new treatment protocols for more ocular infections. However, more research is needed to determine this.

Prevention and treatment of COVID-19: Focus on interferons, chloroquine/hydroxychloroquine, azithromycin, and vaccine

“…Macrolides such as AZM and spiramycin have also shown some activity on Enterovirus species in animal models of Enterovirus A71 infection by relieving the symptoms and increasing the animal survival [ 142 ]. As a senolytic drug, AZM has the ability to accelerate the phagocytic power of macrophages and selectively kills the senescent cells [ 143 , 144 ]. In a retrospective study on Saudi patients with severe MERS-CoV infection, macrolides used according to different regimens showed a weak (but not statistically significant) protective effect on mortality or viral clearance compared to the macrolide-free approach [ 145 ].…”

Efficacy of Azithromycin Eyedrops for Individuals With Meibomian Gland Dysfunction–Associated Posterior Blepharitis

“…Azithromycin is a macrolide antibiotic that possesses anti-inflammatory and immunomodulatory properties that are thought to ameliorate eyelid and ocular surface inflammation. 11 , 18 It thus blocks the activation of nuclear factor–κB and the associated production of proinflammatory chemokines and cytokines such as tumor necrosis factor–α, interleukin (IL)-1β, IL-6, and IL-8 in the eyelid margin and conjunctiva. 6 , 9 , 40 It also has lipase-inhibitory activity and therefore attenuates the production of detrimental free fatty acids at the ocular surface.…”

Antibiotic eluting sinus stents

“…76 Topical azithromycin has been routinely used in the ophthalmologic sphere with minimal adverse outcomes, but topical use in the treatment of airway disease remains an area of intrigue. 77 In addition to its antibacterial properties, azithromycin has significant anti-inflammatory properties through immunomodulation of the neutrophilic response via blockade of NF-kB and downstream interleukin (IL)-8, IL-6, and tumor necrosis factor alpha inflammatory activity. [78][79][80] The combined antibacterial and anti-inflammatory mechanism of macrolides is believed to be part of the underlying mechanism in its ability to reduce polyp size, sinonasal outcome test scores, and IL-8 levels in CRS, particularly in individuals with a noneosinophilic variant.…”

“…Azithromycin is a commonly used antibiotic of the macrolide family that is indicated in the treatment of a number of lower and upper respiratory diseases, including sinusitis, otitis media, and strep throat 76 . Topical azithromycin has been routinely used in the ophthalmologic sphere with minimal adverse outcomes, but topical use in the treatment of airway disease remains an area of intrigue 77 . In addition to its antibacterial properties, azithromycin has significant anti‐inflammatory properties through immunomodulation of the neutrophilic response via blockade of NF‐kB and downstream interleukin (IL)‐8, IL‐6, and tumor necrosis factor alpha inflammatory activity 78‐80 .…”