Can we use azithromycin eye drops for gonococcal ophthalmia prophylaxis in the United States?

ABSTRACT

Introduction

Neonatal ocular prophylaxis with 0.5% erythromycin ophthalmic ointment is mandated by law in many U.S. states despite its lack of efficacy in preventing chlamydial ophthalmia and the low incidence of gonococcal ophthalmia today. The current shortage of 0.5% erythromycin ophthalmic ointment is bringing into question what alternatives exist for neonatal ocular prophylaxis for the prevention of gonococcal ophthalmia. Providers in states with mandates are concerned with the implications of administering intramuscular ceftriaxone to every newborn. Azithromycin eye drops are being considered as an alternative.

Areas covered

This article discusses 1% azithromycin eye drops as an alternative to 0.5% erythromycin ophthalmic ointment. Clinical experience, side effects, resistance, logistics, pharmacokinetics, and pharmacodynamics are considered.

Expert opinion

Azithromycin eye drops are not an appropriate alternative to 0.5% erythromycin ophthalmic ointment for ocular prophylaxis. Prenatal screening and treatment of pregnant women is the most effective way to prevent neonatal ophthalmia. Mandates for universal prophylaxis should be withdrawn to avoid unnecessary medication administration, healthcare costs, and potential harm.

KEYWORDS:

• Gonococcal ophthalmia
• drug shortage
• neonatal conjunctivitis
• ocular prophylaxis
• macrolides

Article highlights

• A shortage of 0.5% erythromycin ophthalmic ointment, the only topical medication currently available in the United States for neonatal ocular prophylaxis, prompts the discussion of an alternative

• Ceftriaxone should not be used in place of erythromycin ophthalmic ointment in low-risk infants in states that mandate universal neonatal ocular prophylaxis due to potential short- and long-term effects of systemic antibiotic administration

• 1% azithromycin eye drops are being considered as an alternative despite no efficacy data and a questionable safety profile

• Azithromycin pharmacokinetics and resistance data should discourage its consideration for neonatal ocular prophylaxis, especially if administered on a universal scale

• Enhanced maternal screening should be prioritized over the search for an alternative to erythromycin ophthalmic ointment

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.

Additional information

Funding

This paper was not funded.