Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns

Tamar A Smith-Norowitz,Margaret R Hammerschlag,Stephan Kohlhoff,Crystal Ukaegbu

doi:10.1186/s12879-021-05974-3

Tamar A Smith-Norowitz, Margaret R Hammerschlag + Show 2 more

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https://doi.org/10.1186/s12879-021-05974-3

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Abstract

BackgroundNeonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due to Chlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established.ObjectiveTo examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC and C. trachomatis in the nasopharynx.MethodsA literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers for C. trachomatis with results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested for C. trachomatis in the eye/ nasopharynx (NP).ResultsThe search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates of C. trachomatis conjunctivitis in infants in included studies who received silver nitrate was 20–33%; positive NP, 1–28% and pneumonia, 3–8%. Rates of C. trachomatis conjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0–15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4–33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0–4% developed chlamydial pneumonia.ConclusionNeonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers with C. trachomatis infection compared to silver nitrate.

Highlights

Credé reported in 1881 that instillation of 2% silver nitrate drops into the eyes of newborn infants reduced the incidence of gonococcal ophthalmia neonatorum [1]
Rates of C. trachomatis conjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0–15 and 11%, respectively, who received erythromycin or tetracycline developed neonatal chlamydial conjunctivitis (NCC)
Neonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers with C. trachomatis infection compared to silver nitrate

Summary

Introduction

Credé reported in 1881 that instillation of 2% silver nitrate drops into the eyes of newborn infants reduced the incidence of gonococcal ophthalmia neonatorum [1]. Prenatal screening and treatment of pregnant women for chlamydia has resulted in a decrease in neonatal chlamydial conjunctivitis and pneumonia [4,5,6]. A study published by Hammerschlag, et al in 1980 suggested that neonatal ocular prophylaxis with erythromycin ointment was effective in prevention of chlamydial conjunctivitis but did not reduce NP infection or pneumonia [12]. A subsequent study [3] demonstrated that neonatal ocular prophylaxis with either erythromycin or tetracycline ophthalmic ointment did not significantly reduce the incidence of chlamydial conjunctivitis in infants of mothers with chlamydial infection as compared with silver nitrate [3]. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established

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