Is Augmentin (amoxicillin-clavulanate) effective for treating blepharitis?

Augmentin for Blepharitis

Augmentin (amoxicillin-clavulanate) is not recommended as a first-line treatment for blepharitis and should be reserved for specific cases of childhood blepharokeratoconjunctivitis (BKC) where other treatments have failed. 1, 2

First-Line Treatment Approach

• The cornerstone of blepharitis management is eyelid hygiene with warm compresses and gentle cleansing of the eyelid margins to remove debris and crusts. 1
• This can be safely accomplished by having the patient gently rub the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaners. 1
• Regular eyelid cleansing, performed daily or several times weekly, often reduces the symptoms of chronic blepharitis. 1

Antibiotic Options for Blepharitis

Topical Antibiotics

• For anterior blepharitis with bacterial involvement, topical antibiotic ointments such as bacitracin or erythromycin applied to the eyelid margins are the preferred first-line antibiotic treatment. 1
• These can be applied one or more times daily or at bedtime for a few weeks, with frequency guided by severity and response. 1
• Topical antibiotics should be rotated periodically to prevent development of resistant organisms. 1

Systemic Antibiotics

• For posterior blepharitis/meibomian gland dysfunction (MGD) not adequately controlled by eyelid hygiene, oral antibiotics may be considered. 1
• Tetracyclines (doxycycline, minocycline) are the preferred systemic antibiotics for adults with MGD. 1
• For children and women of childbearing age, oral erythromycin or azithromycin are recommended alternatives. 1
• Erythromycin dosing for children is typically 30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks. 1

Role of Augmentin in Blepharitis

• Augmentin is not mentioned in the American Academy of Ophthalmology's Preferred Practice Pattern for blepharitis as a standard treatment option. 1, 2
• However, there is limited evidence supporting Augmentin Duo (amoxicillin-clavulanate) use in childhood blepharokeratoconjunctivitis (BKC), a severe form of blepharitis with corneal involvement. 3
• In a small case series of 7 children with BKC, Augmentin Duo showed considerable improvement within the first month of therapy with no recurrences during follow-up in 6 children. 3
• The advantage of Augmentin Duo in this specific population was its twice-daily dosage and favorable side-effect profile compared to erythromycin or doxycycline. 3

Treatment Algorithm for Blepharitis

1. Initial therapy: Warm compresses and eyelid hygiene for 2-4 weeks 2
2. If inadequate response:
   • Add topical antibiotic ointment (bacitracin or erythromycin) 1
   • For posterior blepharitis/MGD, consider oral antibiotics:
     • Adults: Tetracyclines (doxycycline, minocycline) 1
     • Children/pregnant women: Erythromycin or azithromycin 1
3. For severe or resistant cases:
   • Consider Augmentin only for childhood blepharokeratoconjunctivitis not responding to standard therapy 3

Important Considerations

• Blepharitis is typically chronic and requires ongoing management rather than expecting complete cure. 2
• Long-term antibiotic use may lead to resistant organisms, so intermittent treatment is preferable. 1
• Tetracyclines are contraindicated in pregnancy, nursing women, and children under 8 years of age. 1
• Patients with advanced glaucoma should avoid aggressive lid pressure during treatment. 1

Conclusion on Augmentin Use

While Augmentin has shown efficacy in limited studies for childhood blepharokeratoconjunctivitis, it is not a first-line treatment for routine blepharitis cases. Standard treatment with eyelid hygiene and targeted topical or systemic antibiotics (erythromycin, tetracyclines, or azithromycin) should be attempted before considering Augmentin. 1, 2, 3