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Hagen KB, Bedi R, Blackie CA, Christenson-Akagi KJ. Comparison of a single-dose vectored thermal pulsation procedure with a 3-month course of daily oral doxycycline for moderate-to-severe meibomian gland dysfunction. Clin Ophthalmol 2018; 12:161-168. [PMID: 29398903 PMCID: PMC5775735 DOI: 10.2147/opth.s150433] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The aim of this study was to compare the efficacy of a single bilateral 12-minute vectored thermal pulsation (VTP) procedure versus daily oral doxycycline for 3 months for moderate-to-severe meibomian gland dysfunction (MGD). Methods This prospective, randomized, parallel-group, single-masked study included 28 subjects who received either a single-dose VTP or 3 months of doxycycline treatment. At baseline and 3 months post treatment, all subjects were evaluated for the following: dry eye symptoms with a standard dry eye questionnaire (the Standard Patient Evaluation for Eye Dryness [SPEED]), meibomian gland (MG) function by counting the number of glands yielding liquid secretion with the MG evaluator (MGE), tear breakup time (TBUT) and corneal and conjunctival staining. Results In the VTP group, at 3 months, there was a significant improvement in MG function (4.00±1.47 to 7.73±5.53), SPEED score (11.00±3.30 to 5.42±2.15), TBUT (6.26±2.01 to 8.44±1.81), corneal staining (0.38±0.50 to 0.12±0.33) and conjunctival staining (1.69±1.93 to 0.62±0.85). In the doxycycline group, there was a significant improvement in MG function (4.63±1.41 to 10.63±5.91), SPEED score (13.42±4.17 to 9.42±5.47) and conjunctival staining (2.38±1.88 to 1.13±1.51), but the improvement in TBUT (6.90±2.56 to 7.59±2.03) and corneal staining (0.21±0.41 to 0.13±0.34) was not statistically significant (p=0.262 and p=0.414, respectively). At 3 months, SPEED score was significantly better in the VTP group (p<0.05); other parameters were comparable between the two groups. Conclusion A single 12-minute bilateral VTP procedure was significantly more effective than the 3-month daily course of oral doxycycline at improving the dry eye symptoms secondary to MGD. A single 12-minute VTP treatment was at least as effective as a dose of doxycycline for 3 months, in improving MG function and all measured signs of MGD. Given the minimal risk profile of the single VTP procedure over long-term doxycycline use, a single VTP presents a favorable alternative to long-term antibiotic use.
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Affiliation(s)
| | - Raman Bedi
- Iris Advanced Eye Centre, Chandigarh, India
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Abstract
Abnormalities of the gastrointestinal tract due to drug-induced injuries are common and often have important clinical consequences. Medications may cause damage by direct corrosive effects on mucosae or by alter processes, mucosal immunity, and local environmental conditions. The aim of this review is to guide practicing pathologists in the identification of drug-related injuries in gastrointestinal mucosal biopsies and resection specimens. Common causes of injury and their gross, endoscopic, and microscopic features are presented.
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Abstract
Chest pain is common in children seen in emergency departments, ambulatory clinics, and cardiology clinics. Although most children have a benign cause of their pain, some have serious and life-threatening conditions. The symptom must be carefully evaluated before reassurance and supportive care are offered. Because serious causes of chest pain are uncommon and not many prospective studies are available, it is difficult to develop evidence-based guidelines for evaluation. The clinician evaluating a child with chest pain should keep in mind the broad differential diagnosis and pursue further investigation when the history and physical examination suggest the possibility of serious causes.
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Valentín S, Morales A, Sánchez JL, Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clin Cosmet Investig Dermatol 2009; 2:129-40. [PMID: 21436975 PMCID: PMC3047926 DOI: 10.2147/ccid.s4296] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Rosacea is a common, chronic, skin condition characterized by recurrent episodes of facial flushing, transient or persistent erythema, papules, pustules, and telangiectasias, in a symmetrical facial distribution. The etiology of rosacea remains unknown and this condition represents a therapeutic challenge because of its chronic nature, progression, potential for disfigurement and psychological impact. Although there is no curative therapy for rosacea, the most widely used systemic agents are oral tetracycline derivatives, including tetracycline, doxycycline, and minocycline. This article reviews the available evidence for the use of doxycycline, a second-generation tetracycline, in the treatment or rosacea.
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Affiliation(s)
- Sheila Valentín
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Adisbeth Morales
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Jorge L Sánchez
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Abimael Rivera
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
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Sloan B, Scheinfeld N. The use and safety of doxycycline hyclate and other second-generation tetracyclines. Expert Opin Drug Saf 2008; 7:571-7. [PMID: 18759709 DOI: 10.1517/14740338.7.5.571] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tetracyclines have long been used to treat a wide variety of medical conditions, especially in the field of dermatology. Unfortunately, safety concerns, especially gastrointestinal (GI), have always been present. Other safety concerns have included tooth development in children, candidiasis, vestibular concerns, photosensitivity/phototoxicity, and more unusual adverse effects such as uncontrolled hypertension. This article first discusses the pharmacological development of the tetracyclines from the first to the second generation versions with an emphasis on the safety concerns, especially with regards to doxycycline hyclate (DH). Second, the adverse effects of the tetracyclines are discussed. Third, the favorable side effect profile of DH delayed release capsules (Doryx) is compared with DH powder contained in tablets (Vibramycin). Fourth, the increased use with a continued favorable safety profile is also discussed concerning the subantimicrobial dosing of DH for acne. Fifth, the safety of periodontic uses of DH is discussed. Last, the favorable safety profiles of the 2006 approved uses of an anti-inflammatory dose of 40 mg doxycycline for rosacea and an extended-release minocycline tablet for acne are also discussed.
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Affiliation(s)
- Barry Sloan
- St Luke's Roosevelt Department of Dermatology, 150 West 55th Street, NYC, NY 10019, USA.
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Tahan V, Sayrak H, Bayar N, Erer B, Tahan G, Dane F. Doxycycline-induced ulceration mimicking esophageal cancer. CASES JOURNAL 2008; 1:144. [PMID: 18778470 PMCID: PMC2553052 DOI: 10.1186/1757-1626-1-144] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 09/08/2008] [Indexed: 11/18/2022]
Abstract
Introduction Doxycycline-induced esophageal ulcer patients are mostly young persons with no history of esophageal dysfunction. Heartburn, midsternal pain and dysphagia are the most common symptoms. It has generally a benign course. The present case is the first report of doxycycline-induced extensive ulcerations, mimicking esophageal cancer in two esophageal segments alongside, in the literature. Case presentation This report describes a 16-year-old Caucasian girl who, while taking doxycycline capsules100 mg twice a day for acne vulgaris for 3 months, developed these symptoms. An upper endoscopy revealed multiple circumferential deep ulcerations surrounding fragile, irregular, hyperemic and hypertrophic mucosa at the level of the mid-esophagus and concomitantly in the lower esophageal sphincter. The lesions were biopsied to exclude esophageal carcinoma because of the suspicious appearance in the endoscopic examination. The histopathological examination, haematoxylin and eosin stained sections showed ulceration with a mixed inflammatory infiltrate. Doxycycline was discontinued and she was given sucralfate 1 g qid and omeprazole 20 mg bid orally. All symptoms of the patient were resolved on the third day of the treatment. After 4 weeks of the therapy, an upper endoscopic control examination demonstrated normal findings. Conclusion The present case has been an uncommon presentation of doxycycline-induced extensive ulcerations, mimicking esophageal cancer in two esophageal segments, concomitantly. Even the lesions were biopsied to exclude esophageal carcinoma. A modification on the behavior of taking drugs can prevent these unpleasant complications.
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Affiliation(s)
- Veysel Tahan
- Department of Gastroenterology, Pasabahce State Hospital, Istanbul, Turkey.
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Boersma CC, Borowitz SM. Odynophagia. Clin Pediatr (Phila) 2007; 46:556-7. [PMID: 17579111 DOI: 10.1177/0009922806294798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carol C Boersma
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908, USA
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German AJ, Cannon MJ, Dye C, Booth MJ, Pearson GR, Reay CA, Gruffydd-Jones TJ. Oesophageal strictures in cats associated with doxycycline therapy. J Feline Med Surg 2005; 7:33-41. [PMID: 15686972 PMCID: PMC10911547 DOI: 10.1016/j.jfms.2004.04.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Four cases of oesophageal stricture subsequent to doxycycline administration are reported. All cases were young to middle age (median age 3 years; range 1-7 years), and either domestic shorthair or domestic longhair breed. In all cases the predominant clinical sign was regurgitation, which developed at variable times after doxycycline administration. In all cases the reason for doxycycline use was treatment or prophylaxis of suspected infections (Mycoplasma haemofelis, Chlamydophila felis or Bordetella bronchiseptica), and the duration of therapy was variable. In one case the stricture was definitively diagnosed at post mortem examination, in the three other cases, definitive diagnosis was by endoscopy. Balloon dilation was successful in the three cases that were treated. This is the largest case series, to date, of oesophageal disease in cats associated with doxycycline administration. Caution should be exercised when administering oral medication to cats, especially doxycycline, and should be accompanied either by a water or food swallow.
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Affiliation(s)
- Alexander James German
- Department of Clinical Veterinary Science, University of Bristol, Langford House, Bristol BS40 5DU, UK.
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Gencosmanoglu R, Kurtkaya-Yapicier O, Tiftikci A, Avsar E, Tozun N, Oran ES. Mid-esophageal ulceration and candidiasis-associated distal esophagitis as two distinct clinical patterns of tetracycline or doxycycline-induced esophageal injury. J Clin Gastroenterol 2004; 38:484-9. [PMID: 15220682 DOI: 10.1097/01.mcg.0000129058.69524.90] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Tetracyclines may cause esophageal injury. GOALS The aims of this study are to describe 2 distinct clinical patterns of esophageal injury induced by tetracycline or its derivate doxycycline and to compare these patterns with respect to demographic, endoscopic, and clinical characteristics of the patients. STUDY Forty-eight patients with the diagnosis of doxycycline- or tetracycline-induced esophageal injury by endoscopy were analyzed retrospectively. The patients were considered in 2 groups according to the type and the location of esophageal lesions (Group A: mid-esophageal ulceration, n = 18; Group B: distal esophagitis, n = 30). RESULTS Patients in Group A were significantly younger than in Group B (P = 0.0014). In Group A, 15 patients (83%) had single ulceration, 2 (11%) double, and 1 (6%) circumferential at the mid-esophagus. In Group B, all patients had multiple micro-ulcerations in the distal esophagus. Development of mid-esophageal ulceration was induced predominantly by doxycycline, whereas distal esophagitis was induced by tetracycline. The description of drug ingestion with little or no water by patients in Group A was significantly more frequent than in Group B (94% vs. 10%, P < 0.001). Associated medical and benign gastric diseases and esophageal candidiasis were significantly more frequent in Group B (P = 0.006, P < 0.001, P < 0.001, respectively). Prompt response to medical therapy was observed in both groups with no significant difference (P = 0.093). CONCLUSIONS The type of tetracyclines used by patients may give some clues to physicians on the pattern of esophageal injury because mid-esophageal ulceration seems to be more frequently associated with doxycycline and distal esophagitis with or without candidiasis with tetracycline.
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Affiliation(s)
- Rasim Gencosmanoglu
- Division of Gastrointestinal Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey.
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Affiliation(s)
- L Arturo Batres
- Division of Gastroenterology, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, USA.
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Affiliation(s)
- Avinash K Shetty
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27517, USA
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del Valle García Sánchez M, Gómez Camacho F, Poyato González A, Vignote Alguacil M, Miño Fugarolas G. [Doxycycline-induced esophageal ulcer]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:390-1. [PMID: 11674958 DOI: 10.1016/s0210-5705(01)70207-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We present the case of a 25-year-old woman who presented an esophageal ulcer due to doxycycline. We show the endoscopic image of the lesion and analyse the incidence, pathogenic mechanisms, symptomatology, diagnosis, treatment, and prevention of doxycycline-induced esophageal lesions.
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Abstract
BACKGROUND Recent evidence suggests that despite potential side effects, doxycycline should be considered the drug of choice for children of all ages in whom a rickettsial disease is considered in the differential diagnosis of the illness. We hypothesized that doxycycline would be used infrequently for the treatment of suspected rickettsial disease. The objective of the investigation was to determine the initial antibiotic administered to children for whom rickettsial infection was considered likely. METHODS The study population consisted of 35 children evaluated at Texas Children's Hospital between 1987 and 1999 in whom rickettsial disease was a diagnostic consideration. Demographic information and clinical manifestations were assessed through a retrospective chart review. RESULTS Thirty children (86%) presented with fever, 21 (60%) with rash and 14 (40%) with headache, which are typical presenting symptoms for rickettsial diseases. Only 1 of 35 children (3%) was prescribed a tetracycline class antibiotic as initial empiric therapy. Eleven (31%) children received doxycycline during the hospital course. A total of 19 patients, or 54%, received an antimicrobial known to have efficacy in the treatment of rickettsial infection, usually at the suggestion of an infectious diseases consultant. CONCLUSIONS Even among children for whom rickettsial infection is a diagnostic consideration, doxycycline is not prescribed with the frequency that is indicated. Pediatric caregivers should have heightened awareness regarding the appropriate indications for doxycycline use in childhood.
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Affiliation(s)
- J J Purvis
- Division of Allied Health Sciences, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
Corrosive esophagitis is caused by the ingestion of caustic agents. The elderly consume a large number of medications that potentially could cause Drug-Induced Esophagitis (DIE). This article reviews the signs and symptoms, diagnosis, prognosis, and epidemiology of DIE. Drugs reported to cause DIE are reviewed, including alendronate, potassium chloride, antibiotics known to cause DIE, as well as others. Illustrative cases are presented.
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Affiliation(s)
- E Vita
- Drug Information Analysis Service, University of California, San Francisco 94143
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Henry DA, Ostapowicz G, Robertson J. Drugs as a cause of gastrointestinal disease. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1994; 8:271-300. [PMID: 7949459 DOI: 10.1016/0950-3528(94)90005-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- D A Henry
- Faculty of Medicine, University of Newcastle, Mater Miscericordiae Hospital, Waratah, NSW Australia
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