Erythromycin Eye Research Articles

Doxycycline-Induced Intracranial Hypertension Presenting as Unilateral Pulsatile Tinnitus.

Pulsatile tinnitus (PT) is increasingly recognized as a cardinal symptom of idiopathic intracranial hypertension (IIH). However, clinicians should remain aware of other causes of nonidiopathic or secondary intracranial hypertension manifesting as PT. We present 2 patients with isolated PT (without accompanying headache, blurred vision, and papilledema) thought to be secondary to tetracycline-induced intracranial hypertension. To our knowledge, these are the first cases of PT as the presenting symptom of this condition. A 41-year-old female (body mass index [BMI] 29 kg/m2) with ocular rosacea was initially treated with minocycline. Shortly after transitioning to oral doxycycline and erythromycin eye ointment, she noted left-sided PT. Her PT resolved after discontinuing doxycycline. In a second case, a 39-year-old female (BMI 19 kg/m2) with acne presented with a three-year history of left-sided PT while on long-term oral doxycycline for many years. She denied visual or auditory changes and atypical headaches. MRI findings were concerning for intracranial hypertension. Three months later, the patient was seen by neuro-ophthalmology, with findings suggesting prior papilledema. The patient reported PT improvement after discontinuing doxycycline. This case series highlights 2 cases of isolated PT as the sole symptom of intracranial hypertension that resolved with tetracycline cessation. The presentation and unexpected improvement following tetracycline discontinuation are atypical compared with previous reports of tetracycline-induced intracranial hypertension. Clinicians should maintain a high index of suspicion for all types of intracranial hypertension (idiopathic and secondary), even in patients with a lower BMI. Current and prior medications should be reviewed when considering the etiology of intracranial hypertension.

First hepatitis B vaccine uptake in neonates prior to and during the COVID-19 pandemic.

Routine vaccination for hepatitis B is recommended at birth, and most infants should be vaccinated within 24h of life. Historically, vaccination rates have been less than ideal, and routine vaccination has been further complicated by the COVID-19 pandemic, with decreased uptake of many vaccines. This retrospective study assessed hepatitis B vaccination rates at birth before and after the start of the COVID-19 pandemic and explored the factors associated with lower vaccination rates. Infants born at a single academic medical center in Charleston, South Carolina from November 1, 2018 through June 30, 2021 were identified. Infants were excluded if they died or received≥7days of systemic steroid therapy within the first 37days of life. Maternal and infant baseline characteristics and uptake of the first hepatitis B vaccine during hospital admission were recorded. A total of 7808 infants were included in the final analysis, with an overall vaccine uptake of 91.6%. Of the 3880 neonates in the pre-pandemic group, 3583 (92.3%) were vaccinated, versus 3571 (90.9%) of 3928 neonates in the pandemic group (rate difference=1.4%; 95% confidence interval -2.8% to 5.7%, p=0.52). Factors independently associated with lower vaccine uptake included being of non-Hispanic white race, born to a married mother, birth weight<2kg, and parental refusal of erythromycin eye ointment at birth. The COVID-19 pandemic did not significantly affect the uptake of inpatient neonatal hepatitis B vaccination. Several patient-specific factors were associated with suboptimal vaccination rates in this population.

Effects of different eye protection methods during head and neck surgery under general anesthesia

Objective: To compare the protective effects of vitamin A eye gel combined with 3M transparent tape and erythromycin eye ointment combined with 3M transparent tape on the eye surface during head and neck surgery under general anesthesia. Methods: From June to December 2021, a total of 120 patients undergoing elective head and neck surgery under general anesthesia in Beijing Tongren Hospital, Capital Medical University were enrolled. Each participant was randomly received vitamin A eye gel (vitamin A eye, n=60) or erythromycin eye ointment (erythromycin eye, n=60), followed by 3M transparent tape on one eye, and taping 3M transparent tape alone for the other eye. The hand-held slit lamp examination was performed 3 times at before induction of anesthesia, after resuscitation in the post anesthesia care unit (PACU) and 1 day after surgery. The primary outcome was corneal fluorescein sodium staining (CFS) score. Secondary outcomes included symptom assessment in dry eye (SANDE) questionnaire score, basic tear secretion test (Schirmer I test, SIt), break-up time (BUT) and incidence of adverse reactions. Results: Comparison within groups showed that CFS scores were significantly higher in vitamin A eyes and erythromycin eyes at PACU than before induction (P<0.05). Comparison between groups showed that CFS score at PACU in erythromycin eyes (0.62±0.16) was significantly higher than that in vitamin A eyes (0.13±0.01, P=0.007). Compared with before induction, SIt at PACU was significantly increased in the erythromycin eyes [(16.0±1.3) vs (11.4±4.9) mm, P=0.017],and was significantly decreased in vitamin A eyes [(10.2±3.6) vs (12.4±5.5) mm, P=0.046]. The BUT in PACU of erythromycin eyes, vitamin A eyes were (6.4±2.5) s, (6.8±2.1) s, respectively,and were significantly decreased compared with before induction (P<0.05). Comparison between groups showed that there was no significant difference in BUT and SANDE in PACU between two groups (P>0.05). For erythromycin eyes, discomfort symptoms in PACU included viscosity (66.7%, 40/60), conjunctival congestion (21.7%, 13/60), tingling (8.3%, 5/60), blurred vision (58.3%, 35/60). The incidence of these complications in vitamin A eye was 30.0% (18/60), 5.0% (3/60), 0 and 6.7% (4/60), respectively, and all the incidences were significantly higher than those of vitamin A eyes (all P<0.05). Conclusion: For patients undergoing head and neck surgery under general anesthesia, the combination of vitamin A ocular gel and 3M transparent tape is more effective in prevent postoperative ocular surface injury than the combination of erythromycin ointment and 3M transparent tape.

Mulberry Leaf Extract Alleviates Staphylococcus aureus-Induced Conjunctivitis in Rabbits via Downregulation of NLRP3 Inflammasome and Upregulation of the Nrf2 System and Suppression of Pro-Inflammatory Cytokines

Introduction: Mulberry (Morus alba L.) leaves are widely used in traditional Chinese medicine for their antioxidant, anti-inflammatory, antibacterial, anti-obesity, antidiabetic, antiatherosclerotic, and anticancer properties. The current study aimed to investigate the effect of mulberry leaf extract (MLE) on Staphylococcus aureus (S. aureus)-induced conjunctivitis (5 × 10⁹ colony-forming units, 0.5 mL/eye) in a rabbit model. Methods: Rabbits were treated with MLE (5 mL/kg·d⁻¹ and 10 mL/kg·d⁻¹), 0.9% saline, pearl bright eye (PBE) drops, or erythromycin eye ointment (EEO) group for 5 days. The ocular infection symptoms, bacterial negative conversion rate, and conjunctival histopathological changes of rabbits in each group were observed. The expression of caspase-1, apoptosis-associated speck-like protein containing a caspase recruitment domain, NOD-like receptor leucine-rich pyrin domain-containing protein 3 (NLRP3), interleukin (IL)-18, IL-6, IL-1β, TNFα, Keap1, and nuclear factor erythroid 2-related factor 2 (Nrf2) in conjunctival tissue of rabbits were detected by quantitative real-time reverse transcription PCR and/or Western blot analysis. Results: The results showed that MLE treatment significantly reduced the clinical sign scores of conjunctivitis, alleviated clinical signs, and decreased bacterial load, and histological damage in a time- and dose-dependent manner was compared to that in the control group. The antibacterial and anti-inflammatory activities of MLE (10 mL/kg·d⁻¹) were similar to those of the positive control drug PBE and EEO. In addition, MLE significantly decreased the levels of pro-inflammatory cytokines, downregulated the NLRP3 inflammasome, and upregulated the Nrf2 system. Conclusions: MLE is effective in alleviating S. aureus-induced conjunctivitis in rabbits, and this mechanism is associated with the inhibition of the NLRP3 inflammasome and activation of the Nrf2 system to regulate pro-inflammatory signaling.

Application of Easy Wet Healing Therapy for Chronic Noninfectious Wounds in Limbs.

Chronic wounds in limbs without infection are common. This study was to identify an economical, simple, and useful wet healing therapy for patients with chronic noninfectious wounds in the limbs, especially for low-income patients. In total, 56 patients with chronic limb wounds without infection from April 2018 to March 2019 were included. They underwent wound cleaning by iodine and wound covering by recombinant human epidermal growth factor gel, zinc oxide ointment, and erythromycin eye ointment at a 1:1:1 ratio and thickness of 0.8 cm. After applying the drug, a slight-pressure dressing was applied to the wound with a cotton pad and bandage, and the dressing was changed every 3 days. All the wounds completely healed within 12 to 45 days (26.2 ± 11.9 days). The healing time showed a positive correlation with the area of the wound (r = 0.328, P < .05) and the course of disease (r = 0.485, P < .01). The healing time of deep second-degree wounds was 17.2 ± 3.3 days, which was shorter than that of deep third-degree wounds (34.8 ± 8.4 days; P < .05). There was no significant difference in the healing time according to sex. Upper limb wounds healed faster than lower limb wounds (16 ± 2.7 days versus 31.7 ± 9.7 days, P < .05). The simple therapy required a low cost of 0.07 dollars per square centimeter for each dressing change. This wet healing therapy is easy, effective, relatively safe, and affordable, with no obvious side effects.

108. HEPATITIS B VACCINATION IN DUKE UNIVERSITY AND DUKE REGIONAL HOSPITAL NEWBORN NURSERIES

Background Vertical transmission continues to be a mode of Hepatitis B virus (HBV) infection despite implementation of prenatal maternal screening. HBV vaccination induces seroprotection in 98% of term infants. The CDC recommends that all infants should receive the first dose of hepatitis B vaccine at birth or within the first 12- 24 hours of life before they leave the hospital. Nevertheless, HBV vaccination rates prior to discharge were sub-optimal in the Duke newborn nurseries, which consist of the main Duke University Hospital (DUH) nursery and the community-based Duke Regional Hospital (DRH) nursery. Aim Statement We aimed to increase all HBV vaccination rates from a baseline of 94% to 96% at the DUH and from 88% to 90% at the DRH nurseries within 1 year. Interventions Baseline HBV vaccination rates were obtained from the electronic medical record (EMR) by using the 12 months preceding first intervention. The first intervention educated clinicians and nurses on the updated CDC guidelines by displaying posters in work areas. The second intervention aimed to increase project awareness among nursing staff in the nursing newsletter. The third intervention was an interdisciplinary effort among the nursing, physician, and pharmacy teams to coordinate administration of the HBV vaccine with the routine administration of vitamin K injection and erythromycin eye ointment at delivery. Measures After each intervention, a PDSA cycle was completed, assessing vaccination rates over the next three months on average. We assessed the effect on nursing workflow through a survey as a balancing measure. Results At both DUH and DRH nurseries respectively, we saw the rates of HBV vaccination increase slightly from baseline rates of 88% and 94% to 92% and 95% after the first two cycles. The third intervention at DUH resulted in a robust response in vaccination rates (up-trending to 95.8% in the month of November). Rates have been above the means for 7 and 10 consecutive months for DUH and DRH since the project began. Conclusions and Next Steps We have demonstrated a trend in improvements in HBV vaccination rates in the DUH and DRH newborn nurseries over several PDSA cycles. Most notably, the multi-disciplinary intervention of administering HBV with the vitamin K injection and erythromycin eye ointment at DUH had a marked impact. Continued multi-disciplinary efforts to improve HBV vaccination in the newborn nursery at both hospitals will optimize the care of newborn infants in prevention of HBV.

Clinical effect of combined bandage contact lenses and artificial tears on corneal epithelial injury due to correction of blepharoptosis

Objective To explore the effect of the combination of bandage contact lenses and artificial tears on corneal epithelial injury, due to correction of blepharoptosis in patients. Methods Thirty-five patients (56 eyes) were included in this randomized controlled trial during May 2013 to May 2018, and randomly divided into observation group (combination of bandage contact lenses and artificial tears) and control group (combination of erythromycin eye ointment and artificial tears), and followed up for 3 months. The corneal wound healing, corneal fluorescent staining (FL), Schirmer test (Slt), break-up time (BUT) and the severity of eye pain were documented and compared by statistical method. Results The scores of FL in the observation group were reduced (t=-3.211, P 0.05; the scores of eye pain, t=-1.800, P>0.05; the corneal wound healing, χ2=1.018, P>0.05; the BUT score, t=1.661, P>0.05). Conclusions The combination of bandage contact lenses and artificial tears is recommended for the early use after correction of blepharoptosis, to alleviate eye symptoms and promote corneal wound healing. Key words: Blepharoptosis; Corneal injuries; Ptosis; Corneal epithelial injury; Contact lens

Case 3: Two-Day-Old Infant with Purulent Eye Discharge

A term male infant born via spontaneous vaginal delivery has Apgar scores of 9 and 9. Two days after birth, he is noted to have copious purulent discharge with mild conjunctival edema of the left eye and mild discharge from the right eye. Erythromycin eye ointment is administered to the neonate shortly after birth per routine protocol. Maternal medical history is noncontributory, with her obstetric record showing no history of sexually transmitted infections (STIs). Warm compresses and tear duct massage are ordered based on a suspicion of nasolacrimal duct obstruction. Overnight the infant develops increased eye drainage. On physical examination, the upper eyelids appear edematous and erythematous (left greater than right) with purulent discharge bilaterally, similar to the infant in the Fig. The conjunctivae are noted to be beefy red. Eye cultures are performed and gentamicin ointment administered. Figure. Newborn with gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection. (Courtesy of Centers for Disease Control and Prevention Public Health Image Library (PHIL), identification number #3766. CDC/ J. Pledger.) Three days after birth, in the setting of worsening bilateral edema and copious drainage, the parents are questioned in greater detail regarding their STI history. At this time, the mother discloses that 3 days before delivery she had undergone STI testing because the infant’s father had been recently treated empirically for an STI. The mother is currently unaware of her test …

Incidence of Phthiriasis palpebrarum caused by pubic lice Pthirus pubisin Al-Sulaimaniyah province, Kurdistan region, Iraq

Phthiriasis palpebrarum is a rare infection caused by pubic lice Pthirus pubis. Thisparasite has become a public health problem since itinfestshuman eyes and has beenlinked with other infections like keratitis, conjunctivitis and blepharitis. The presentstudy was carried out on 2325 patients attended Doctor Shahid Aso Hospital in Al-Sulaimaniyah province, Kurdistan region, Iraq from January to November 2017. Fourpatients were observed to have symptoms like itching, redness, swollen of the eyelidswith the presence of tiny white objects at the base of their eyelashes . Throughexamination using slit lamp and florescent microscopes, it was observed that theinfections were caused by infestation with adults and nymphs of Pthirus pubis. Liceand nits were removed mechanically using fine forceps followed by treatment of thepatients with erythromycin eye ointment. All the patients were treated successfully. Tothe best of our knowledge this is the first documentation of phthariasis papebrarum inKurdistan and Iraq. Further studies are required for better understanding the ecology,phylogeny and the potential of disease transmission of the parasite.

Classification and corrective methods of obviously asymmetric palpebral fissure of single-fold eyelid

To discuss the classification of obviously asymmetric palpebral fissure of single-fold eyelid and their corrective methods performed with double-fold eyelid blepharoplasty simultaneously. Forty patients with obviously asymmetric palpebral fissure of single-fold eyelid of two eyes were admitted to Linyi People's Hospital in Shandong province from January 2010 to September 2014, asking for double-fold eyelid blepharoplasty. The preoperative difference of palpebral fissure width between two eyes reached 1.0-2.0 (1.44±0.23) mm. Obviously asymmetric palpebral fissures of single-fold eyelid were divided into three types according to the characteristics of eyelids of two eyes and were corrected by following methods performed with double-fold eyelid blepharoplasty with total incision simultaneously. (1) Twenty-four patients only with different sagging skin of upper eyelids were corrected by resecting sagging skin of eyelids' margins, and the width of the widest position of resected eyelids' skin was twice as wide as that of the sagging skin of eyelids' margins (the same below). (2) Among 6 patients only with different palpebral fissure width, 4 patients whose difference of palpebral fissure width was not bigger than 1.4 mm were corrected by the method of resecting surplus skin, and the width of the widest position of resected eyelids' skin with narrower palpebral fissure was 1 mm wider than the difference of palpebral fissure width between two eyes (the same below). The other 2 patients whose difference of palpebral fissure width between two eyes was bigger than 1.4 mm were corrected by the method of resecting surplus skin and shortening aponeurosis of levator muscle of upper eyelid. The width of shortened aponeurosis of levator muscle of eyelids with narrower palpebral fissure was 1 mm wider than difference of palpebral fissure width between two eyes (the same below). (3) Among 10 patients with mixing symptoms of sagging upper eyelids skin and difference of palpebral fissure width bigger than 1.0 mm after smoothing sagging upper eyelids' skin, 7 patients whose difference of palpebral fissure width was not bigger than 1.4 mm were corrected by resecting sagging skin and the method of resecting surplus skin. The other 3 patients whose difference of palpebral fissure width was bigger than 1.4 mm were corrected by resecting sagging skin, shortening aponeurosis of levator muscle of upper eyelids and resecting surplus skin. Palpebral fissure widths of patients were measured during follow-up. Difference of palpebral fissure width between two eyes was calculated and the last difference was recorded. Data were processed with paired sample t test. Nine patients who showed incomplete closure of palpebral fissure on the sides of resected eyelids skin or shortened aponeurosis of levator muscle of upper eyelids after operations were treated with erythromycin eye ointment drop in eyes and recovered one week to one month after operations, with no complication of conjunctivitis or keratitis. Double-fold eyelids of all patients who were followed up for 8 to 12 months showed natural shape, smooth lines. No patient showed obvious asymmetry of palpebral fissure between two eyes, and no recurrence of asymmetric palpebral fissure was observed. Difference of palpebral fissure width was 0.1-0.5 (0.19±0.09) mm in the last follow-up, which was obviously smaller than that before operation (t=39.202, P<0.001). Obviously asymmetric palpebral fissure of single-fold eyelid can be corrected during the operation of double-fold eyelid blepharoplasty. Patients only with different sagging skin of upper eyelids can be corrected by resecting sagging skin of eyelids' margins. Patients only with different palpebral fissure width between two eyes can be corrected by the method of resecting surplus skin or combining the method of shortening aponeurosis of levator muscle of upper eyelids. Patients with different sagging skin of upper eyelids and different palpebral fissure width can be corrected by resecting sagging skin of eyelids' margins and the method of resecting surplus skin or combining the method of shortening aponeurosis of levator muscle of upper eyelids.

Effects of Topical Antibiotic Prophylaxis on Wound Healing After Flapless Implant Surgery: A Pilot Study.

The purpose of this pilot study is to investigate the effects of local application of minocycline hydrochloride ointment (MHO) and erythromycin eye ointment (EEO) on wound healing after flapless implant surgery. Forty patients with flapless implant surgery were enrolled and assigned randomly to three groups: 1) MHO group (n = 17); 2) EEO group (n = 18); and 3) control group (n = 5). All of them took systemic antibiotics; the control group did not receive the application of topical antibiotics. Three days after the surgical operation, clinical parameters, peri-implant crevicular fluid volume, and crevicular lipopolysaccharide (LPS) levels of all patients were collected, measured, and analyzed. Clinical outcomes of the two treatment groups were superior to results of the control group, indicating the effectivity of local antibiotics application in promoting early wound healing after flapless implant surgery. There was no obviously different effect between EEO and MHO in the early stages of healing. In addition, there were significant correlations between LPS level and all clinical parameters. The local application of antibiotics along with the systemic antibiotics could reduce the inflammatory response in wound healing after implant surgery. The EEO and MHO were equally effective in early wound healing. Compared to the MHO, the EEO has advantages of higher cost efficiency and convenience. Therefore, it is recommended to use the EEO in topical antibiotic prophylaxis for wound healing after flapless implant surgery.

Reasons for Refusal of Newborn Vitamin K Prophylaxis: Implications for Management and Education.

The American Academy of Pediatrics recommends intramuscular (IM) vitamin K prophylaxis for all newborns to prevent vitamin K deficiency bleeding. Given the serious implications of late-onset vitamin K deficiency bleeding, our objective was to examine factors influencing parents' decisions to refuse IM vitamin K prophylaxis. Parents intending to refuse IM vitamin K prophylaxis at delivery were recruited from 5 community hospitals, 1 academic medical center, and 2 birthing centers in a single Southeastern state. Participants completed a written survey including demographics, birth and parenting decisions (eg, breastfeeding), and open-ended questions about their vitamin K information sources, concerns, and knowledge of risks. The incidence of refusal was highest at the birthing centers. Fifty-four parents intending to refuse IM vitamin K completed the survey. Most were white (78%), over age 30 (57%), and college graduates (65%). All reported intention to exclusively breastfeed. Most refused hepatitis B vaccine (90%) and erythromycin eye ointment (77%). The most common source of information was the Internet (70%). Concerns included synthetic or toxic ingredients (37%), excessive dose (28%), and side effects (24%). Eighty-three percent of parents reported awareness of risks associated with vitamin K refusal. However, only 6 parents (11%) decided to accept IM prophylaxis. This study provides an understanding of the concerns, mindset, and information sources used by parents refusing IM vitamin K. Educating parents about the importance of IM prophylaxis should begin in the prenatal period and must address concerns parents identify on the Internet.

Prophylaxis of Ophthalmia Neonatorum Comparison of Betadine, Erythromycin and No Prophylaxis

Ophthalmia neonatorum is a form of bacterial conjunctivitis contracted by newborns during delivery and occurs during the first month of life. Etiologic factors include Neisseria gonorrhoeae, Chlamydia trachomatis, viruses and chemicals. Its prevalence differs in different parts of the world and is dependent mainly upon socioeconomic conditions, level of knowledge about general health, standard of maternal healthcare as well as the type of prophylactic program used. This randomized clinical trial was performed during the years 2004-05 in the Delivery Section of Vali-e-Asr Hospital on 330 neonates who were divided into three equal groups of 110; Group A received betadine eye drops, Group B received Erythromycin eye drops and Group C (control group) received no treatment. Results showed that clinical conjunctivitis occurred in 52 subjects (17%), 58% of whom constituted males. On the whole, 9% of the infected newborns were from group A, 18.4% from group B and 22.4% from group C. It was concluded that 2.5% sterile betadine eye drops had a pronounced effect on ophthalmia neonatorum (p = 0.030).

Outbreak of erythromycin-resistant staphyloccal conjuctivitis in a new born nursery

We investigated an outbreak of erythromycin-resistant Staphylococcus aureus conjunctivitis in a hospital newborn nursery that used erythromycin eye ointment to prevent ophthalmia neonatorum. Cases occurred in 2 clusters; 20 (14%) of 146 infants in the nursery developed conjunctivitis from July through October, 1987; and 5 (7%) of 69 infants in the nursery developed conjunctivitis during April and May, 1988. A case-control study of the first cluster demonstrated that culture-confirmed cases were more likely than controls to have received prophylactic erythromycin eye ointment or their initial bath from one nurse (odds ratio, 9.0; P = 0.01) or to have been delivered by one physician (odds ratio, 12.7; P = 0.03). The nurse was the only staff person to have a nasopharyngeal culture which yielded erythromycin-resistant S. aureus. Control measures, instituted in October, 1987, included using silver nitrate drops instead of erythromycin eye ointment for prophylaxis; however, in January, 1988, the hospital resumed use of erythromycin eye ointment. No additional cases were identified until mid-April, 1988, when the second cluster of cases occurred. At that time the hospital reinstituted the use of silver nitrate and no additional cases were identified. This investigation illustrates the potential for conjunctival infection with an antimicrobial-resistant pathogen when antimicrobials are used to prevent ophthalmia neonatorum.

Intentions to communicate positive HIV-antibody status to sex partners

<h3>To the Editor.</h3> —I would like to commend Horsburgh et al¹on their article entitled "Preventive Strategies in Sexually Transmitted Diseases for the Primary Care Physician" in the Aug 14 issue ofThe Journal. I would like to mention, however, that topical treatment with erythromycin and tetracycline is not definitely effective in preventing chlamydial conjunctivitis. It was interesting to note in their article that the recommendation to use erythromycin eye ointment for prevention of ophthalmia neonatorum by<i>Chlamydia trachomatis</i>received the highest recommendation based on one study performed by Hammerschlag et al.²Hammerschlag and colleagues recently repeated a prospective study to evaluate erythromycin, tetracycline, and silver nitrate drops for the prevention of chlamydial conjunctivitis in a somewhat larger population than in their original study. Of 118 infants born to<i>Chlamydia</i>-positive women, 11% who received silver nitrate, 13% who received erythromycin ointment, and 16% who received tetracycline ointment

Preventive Strategies in Sexually Transmitted Diseases

To the Editor. —I would like to commend Horsburgh et al 1 on their article entitled Preventive Strategies in Sexually Transmitted Diseases for the Primary Care Physician in the Aug 14 issue ofThe Journal. I would like to mention, however, that topical treatment with erythromycin and tetracycline is not definitely effective in preventing chlamydial conjunctivitis. It was interesting to note in their article that the recommendation to use erythromycin eye ointment for prevention of ophthalmia neonatorum by Chlamydia trachomatis received the highest recommendation based on one study performed by Hammerschlag et al. 2 Hammerschlag and colleagues recently repeated a prospective study to evaluate erythromycin, tetracycline, and silver nitrate drops for the prevention of chlamydial conjunctivitis in a somewhat larger population than in their original study. Of 118 infants born to Chlamydia -positive women, 11% who received silver nitrate, 13% who received erythromycin ointment, and 16% who received tetracycline ointment