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Blepharitis - Management
What dosing regimen of tetracyclines should I prescribe?
- Tetracyclines are not specifically licensed for the treatment of blepharitis. Tetracycline and oxytetracycline are licensed for the treatment of rosacea which often accompanies chronic blepharitis; doxycycline and lymecycline are not licensed for rosacea [BNF 54, 2007].
- Because evidence from controlled trials and product information are lacking, the optimal regimen of tetracyclines in the treatment of blepharitis is based on expert opinion. In general, low doses are initiated (compared with doses used for acute infections), as they are being used in an anti-inflammatory role rather than as an antibiotic. After the condition has improved noticeably (usually after 2–4 weeks), the dose can be further reduced for maintenance [American Academy of Ophthalmology, 2003].
- Treatment should be continued for at least 6 weeks. However, clinical experience has shown that longer courses of tetracyclines (e.g. 3 months) may provide better responses [Dart, Personal Communication, 2004].
- Table 1 lists the doses of tetracyclines for the treatment of blepharitis, as recommended by CKS.
Table 1. Recommended tetracycline dosing regimen for the treatment of chronic blepharitis.
Tetracycline product | Initial dose (4 weeks) | Maintenance dose (8 weeks) |
|---|
Tetracycline tablets | 500 mg twice a day | 250 mg twice a day |
Oxytetracycline tablets | 500 mg twice a day | 250 mg twice a day |
Lymecycline capsules | 408 mg once a day | 408 mg once a day* |
Doxycycline capsules | 100 mg once a day | 50 mg once a day |
* Unavailable in lower doses. |
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