Neonatal ocular prophylaxis in the United States: is it still necessary?

ABSTRACT

Introduction

Much has changed since Credé reported that silver nitrate decreases the incidence of ophthalmia neonatorum. Prenatal screening and treatment of pregnant women for Neisseria gonorrhoeae became standard in the 1950s and for Chlamydia trachomatis in 1993. Neonatal gonococcal and chlamydial conjunctivitis are consequently uncommon today. Currently, only 0.5% erythromycin ophthalmic ointment is available in the United States (U.S.) for neonatal ocular prophylaxis, which is ineffective against C. trachomatis.

Areas covered

This article addresses the altered epidemiology of ophthalmia neonatorum in the U.S. since prophylactic practices began, the lack of data supporting ophthalmic erythromycin for prevention of neonatal gonococcal and chlamydial conjunctivitis, and the impact of prenatal screening and treatment of pregnant women for N. gonorrhoeae and C. trachomatis on conjunctivitis incidence. The authors discuss why erythromycin ophthalmic ointment is likely ineffective against gonococcal ophthalmia, including the development of macrolide resistance. Physiologic limitations and pharmacokinetic properties are considered with respect to ophthalmic erythromycin for the prevention of gonococcal and chlamydial conjunctivitis.

Expert opinion

Administration of erythromycin ophthalmic ointment for the prevention of neonatal conjunctivitis is not literature-supported. Prenatal screening and treatment of pregnant women is the most effective way to prevent ophthalmia neonatorum. National mandates for prophylaxis should be withdrawn.

KEYWORDS:

• Gonococcal ophthalmia
• chlamydial ophthalmia
• neonatal conjunctivitis
• ocular prophylaxis
• erythromycin
• macrolides

Article highlights

• Neonatal ocular prophylaxis for the prevention of ophthalmia neonatorum was first introduced by Credé in 1881.

• Neonatal gonococcal and chlamydial conjunctivitis are uncommon today due to the introduction of prenatal screening and treatment of pregnant women for Neisseria gonorrhoeae in the 1950s and for Chlamydia trachomatis in the 1990s.

• 0.5% erythromycin ophthalmic ointment is the only medication available for neonatal ocular prophylaxis in the U.S. today and does not prevent chlamydial conjunctivitis.

• Data on the efficacy of 0.5% erythromycin ophthalmic ointment for the prevention of gonococcal conjunctivitis are limited and difficult to assess in settings where prenatal screening is routine, but the development of macrolide resistance and pharmacokinetic and physiologic limitations indicate it is likely ineffective as prophylaxis.

• Given the changed epidemiology of ophthalmia neonatorum in the U.S. and the impact of prenatal screening and treatment of N. gonorrhoeae and C. trachomatis on the incidence of neonatal ophthalmia, neonatal ocular prophylaxis mandates should be withdrawn.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Listed authors have substantially contributed to the conception and design of the review article, the review of relevant literature, and the writing and revision of the article.

Additional information

Funding

This paper was not funded.