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Lack of eye ointment alone to protect newborns from gonorrhea-related eye infections calls for alternative options
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Most babies born in the US are given an antibiotic eye ointment immediately after birth. This prevents a potentially serious eye infection that can be caused by chlamydia, gonorrhea or other bacteria passed from parent to infant at birth.
Unfortunately, there is currently a lack of erythromycin 0.5% ophthalmic ointmentWhat is the only the regimen recommended for this use. With no end in sight to the shortage, the Centers for Disease Control and Prevention (CDC) recently released recommendations for health care providers and hospitals who cannot take this medicine.
Those alternatives include another ointment that could also be used to treat infants who may have been exposed to chlamydia and gonorrhea at birth, but the agency stresses the importance of prenatal STI screening for pregnant women. This is the best way to protect both them and their babies from possible long-term consequences.
Infants exposed to bacteria such as chlamydia and gonorrhea at birth may develop ophthalmia neonatorum or conjunctivitis neonatorum. This can cause red, swollen and cloudy eyes. If left untreated, it can lead to inflammation of the iris (the colored part of the eyes), a scar or hole in the cornea, or blindness.
Treating all infants as a precaution is important. Without it, an infant born to a mother who has gonorrhea, for example, has a 30% to 50% chance of becoming infected.
The shortage of erythromycin ophthalmic ointment continues from 2022, because many pharmaceutical companies stopped producing it or reduced their production. To help alleviate the shortage, the FDA has temporarily approved a similar formula made by a Canadian company for sale in the United States.
The CDC says that any provider who has access to erythromycin ophthalmic ointment (0.5%) should continue to use it. Then he offers three alternative prevention options for those who don’t find it.
- The first option is a different prophylactic eye drop called azithromycin 1% ophthalmic solution. This is not ideal because this drug is more expensive and has not yet been proven to prevent neonatal ophthalmia. That said, the CDC believes it will work based on available pharmacologic data, limited prior use, and expert opinion.
- The second option involves testing all birth parents for gonorrhea and chlamydia at the time of delivery and providing treatment to parents and infants who test positive.
- The third option requires treating those infants born to parents who are at higher risk for gonorrhea. This includes parents who had prenatal care, those with a history of STIs during pregnancy, and those with a history of substance use.
With options two and three, babies will be treated with an injection of antibiotics (either ceftriaxone or cefotaxime).
It is important that providers understand these alternatives, but the CDC emphasizes that the best way to prevent chlamydia and gonorrhea infections in newborns is to screen all pregnant women for these STIs early in pregnancy and again in the following months. Anyone who tests positive can be treated before giving birth to avoid the risk of parent-to-child transmission.
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