Erythromycin and Infant Eye Care
Newborns are routinely given erythromycin eye ointment after birth. This prevents pink eye in the first month of life which, if left untreated, can result in blindness. Ophthalmia neonatorum (ON) is a result of a sexually transmitted infection, usually chlamydia but sometimes gonorrhea, and a newborn can become infected if they are vaginally birthed by a mother who has an active infection at the time of delivery.
Historically, drops of silver nitrate were dropped into the newborn's eyes, which resulted in a profound reduction in the number of cases of blindness in children. Silver drops came with some pretty negative side effects, namely pain, irritation, and temporary visual disturbances. But since the pros outweighed the cons, this medical practice was adopted, and eventually came to be applied on all babies, whether or not the mother had an active infection at the time of delivery.
By 1953, with the advancement of antibiotics, silver drops were replaced more commonly with a swabbing of erythromycin eye gel. However, more recent studies have called into question whether this intervention is effective, as its ability to prevent gonorrhea and chlamydia has been shown to be questionable. Further, concerns of antibiotic resistance may mean erythromycin is less effective today, rendering those older studies that provided evidence for eye ointment prophylaxis less relevant.
Screening and treatment strategies
There is much debate about whether this prophylactic intervention is actually needed. In 2015, the Canadian Pediatric Society recommended discontinuing the routine use of eye ointment prophylaxis, proposing a screening and treatment strategy as an alternative to required prophylaxis, that includes the following recommendations:
- Screen all pregnant people for gonorrhea and chlamydia at first prenatal visit.
- Positive test results require treatment with antibiotics during pregnancy and a re-test in the third trimester (or, failing that, at the time of birth with the most rapid tests available); partners should also be treated.
- Negative test results require repeat screening in the third trimester (or at the time of birth) if the mother was at high risk of contraction.
- If the mother tests positive for gonorrhea at the time of birth, the newborn should be treated with injectable antibiotics without waiting for test results and should be further evaluated if unwell in any way. This recommendation includes babies born by C-section.
- If the mother tests positive for chlamydia at the time of birth, then the newborn should be closely watched for symptoms of pink eye and treated only if the infection occurs.
While most US states still require the use of erythromycin within 24 hours of birth, as recommended by the US Preventive Services Task Force and promoted by the American Association of Family Physicians, in 2018 the American Academy of Pediatrics called for a re-evaluation of state mandates for erythromycin eye ointment. They have proposed a strategy similar to that used in Canada, which includes prenatal screening and treatment, testing anyone previously unscreened at time of birth, counselling parents to seek immediate medical attention if baby shows signs of pink eye, and continuing with the mandatory reporting of all cases of gonorrhea. The AAP still deems that routine erythromycin eye treatment remains appropriate in regions with high rates of gonorrhea, and where prenatal screening and treatment is not widely accessible.
Educating yourself on what to expect during pregnancy and birth can help empower you to make the best choices for both you and your new babe! The reassessment of the benefits of erythromycin is just one way that society is reshaping the birth process. Get to know your country and state laws, talk to your healthcare provider, and do a little research! Let the eyes have it!