Why is erythromycin recommended instead of silver nitrate

Action Steps For parents: Take this article to an appointment and discuss it with your care provider! Can we go over my prenatal screening history and discuss my test results for infectious diseases? Can we discuss my personal risk status for infection with chlamydia and gonorrhea? What will happen if I decide to refuse the erythromycin eye ointment?

What is their screening status? Have they been screened for gonorrhea and chlamydia during the current pregnancy or at the time of birth with a rapid test, if available? If the test was positive, were they treated with antibiotics along with their partner s and re-tested? If the test was negative but the mother is at high-risk for sexually transmitted infections, were they re-tested in the third trimester or at the time of birth?

What is their risk status? Do they claim to be in a monogamous relationship or have multiple sexual partners? How old are they? Women under 25 years of age are more at risk for gonorrhea and chlamydia. Do they live or travel to a place where the rate of gonorrhea or chlamydia is high? Did they give birth vaginally or by Cesarean? If the mother gave birth by Cesarean, were her membranes intact at the time of the surgery? If the baby develops pus-containing pink eye, will they receive timely medical care?

Have they been advised to watch for signs of pus-containing pink eye and bring the infant in for medical care immediately if it occurs? Lack of adequate prenatal care, insurance, or permanent housing could be an indication that access to medical care may be a barrier should the infant require treatment for ON. References: American Academy of Pediatrics In: Kimberlin, D. Amini, E. A five-year study in Iran of ophthalmia neonatorum: prevalence and etiology. Med Sci Monit, 14 2 , CR Baynham, J.

Antibacterial effect of human milk for common causes of paediatric conjunctivitis. Br J Ophthalmol, 97 3 , Bramantyo, T. Asia Pac J Ophthalmol Phila , 4 3 , Bremond-Gignac, D. Ophthalmology and Eye Diseases , 3 , 29— Bruschweiler-Stern N.

The neonatal moment of meeting—building the dialogue, strengthening the bond. Jul;18 3 Canadian Pediatric Society Preventing ophthalmia neonatorum. Paediatr Child Health;20 2 Antibiotic resistance threats in the United States, Accessed June 20, Sexually Transmitted Diseases Surveillance.

Accessed November 12, Chen, J. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis. Pediatr Infect Dis J, 11 12 , Coutanceau, B. Case Rep Obstet Gynecol, , Darling, E.

McDonald Diener, B. Cesarean section complicated by gonococcal ophthalmia neonatorum. J Fam Pract, 13 5 , , Dunn, P. Farroni, T. Eye contact detection in humans from birth.

Ghaemi, S. Evaluation of preventive effects of colostrum against neonatal conjunctivitis: A randomized clinical trial.

J Educ Health Promot, 3 , Givner, L. Chlamydia trachomatis infection in infant delivered by cesarean section. Pediatrics, 68 3 , Hammerschlag, M. Chandler, et al. Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis. N Engl J Med, 12 , Hedberg, K. Outbreak of erythromycin-resistant staphylococcal conjunctivitis in a newborn nursery.

Pediatr Infect Dis J, 9 4 , Ibhanesebhor, S. In vitro activity of human milk against the causative organisms of ophthalmia neonatorum in Benin City, Nigeria. J Trop Pediatr, 42 6 , Isenberg, S. A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum. N Engl J Med, 9 , Jacobsen, T. Ugeskr Laeger, 37 , Jefferies, J. C, Cooper, T. Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit — a systeatic review of risk factors and environmental sources.

Journla of Medical Microbiology, 61, Protocol: Interventions for preventing ophthalmia neonatorum. Cochrane Database of Systematic Reviews , Issue 9. Khan, F. Efficacy of 2. J Coll Physicians Surg Pak, 26 2 , Laga, M. Pamba, H. Prophylaxis of gonococcal and chlamydial ophthalmia neonatorum. A comparison of silver nitrate and tetracycline. N Engl J Med, 11 , Lund, R. Prophylaxis against gonococcal ophthalmia neonatorum. A prospective study. S Afr Med J, 72 9 , Medves, J.

Centers for Disease Control and Prevention. Erythromycin 0. Centers for Disease Control and Prevention website. Updated March 12, Prevention of neonatal ophthalmia. Severe ocular reactions after neonatal ocular prophylaxis with gentamicin ophthalmic ointment.

Pediatr Infect Dis J. Periocular ulcerative dermatitis associated with gentamicin ointment prophylaxis in newborns. J Pediatr. Merlob P, Metzker A. Neonatal orbital irritant contact dermatitis caused by gentamicin ointment. McElhiney LF. Developing an erythromycin ophthalmic ointment: putting the puzzle pieces together.

Int J Pharm Compd. Pediatric Drug Formulations. Gov't, P. Substances Erythromycin Silver Nitrate. Gentamicin ophthalmic ointment is still considered a potential alternative option when erythromycin ophthalmic ointment and azithromycin ophthalmic solutions are not available. A last-line option would be a fluoroquinolone ophthalmic ointment such as ciprofloxacin ophthalmic ointment 0.

Fluoroquinolone resistance to N. There were , cases of gonorrhea reported in in the United States, making it the second most frequently reported infectious disease after chlamydia. Consequently, cephalosporin-based regimens are the first-line recommendation for treatment of gonococcal infections, with ceftriaxone as a treatment choice for all types of N.

The rate of gonorrhea cases remained relatively stable for the last decade. Of concern, resistance rates continue to rise while there is a lack of new prospective therapy options for N. This stresses the importance of preventing the spread of N. To ensure that the most effective available prophylaxis option for ophthalmia neonatorum caused by N. Although initial estimates were that supplies of erythromycin ophthalmic ointment would return to sustainable levels in early , the supply remains very limited.

Many centers that developed initial contingency plans in the summer are now being forced to select alternate agents. Additionally, it is important for infectious diseases practitioners to know that these practice changes have been occurring as we continue to track the epidemiology of these infections. Healio News Pediatrics.

Issue: March