Neonatal ocular prophylaxis: Shortage of erythromycin ophthalmic ointment for use in newborns

There is currently a shortage of erythromycin ophthalmic ointment for newborn ocular prophylaxis.

Erythromycin is the only product licensed for this purpose in Canada. Alternative available ophthalmic antibiotics have not been tested for safety nor efficacy for prophylaxis in newborns.

If erythromycin is unavailable, we suggest following the recommendations published by the Canadian Paediatric Society in 2015.

• If the newborn’s mother has been tested for gonococcus in pregnancy and found to be negative: No further action is necessary, unless the mother is considered to be at high risk of acquiring gonococcus after the test was done. 
   
• If the mother is at high risk for exposure to gonococcus after last testing, OR tested positive for gonococcus in pregnancy and was treated but not followed up, OR was not tested in pregnancy:  Test the mother at delivery. Following delivery:
  
       – If close follow-up of the newborn can be assured, the infant may be discharged while awaiting results. The health care professional who will follow the infant should be informed of the situation, and the parents should be informed who to contact immediately if the infant develops eye irritation or discharge. This requires coordination between the health care professionals present at delivery and those who will follow the baby (eg., paediatrician, family physician, midwife, nurse or other).
  
       – ONLY if close follow-up of the newborn pending test results cannot be assured AND it is NOT possible for the infant to remain in hospital while awaiting results, a dose of intramuscular ceftriaxone (50 mg/kg to a maximum of 125 mg) should be given to the infant before discharge.  

• If the mother tested positive for gonococcus in pregnancy but was not treated, and the baby is asymptomatic:  Assume the infant is infected. Test a conjunctival specimen for gonococcus, and treat the infant with a single dose of ceftriaxone, pending test results.  

• Ocular prophylaxis with erythromycin has limited or no effect in prevention of chlamydia conjunctivitis. Treatment of exposed asymptomatic infants with a systematic macrolide is not indicated.  

For further details about managing an infected or symptomatic infant, maternal screening, identifying high-risk mothers, and managing infants exposed to chlamydia at birth, see Preventing ophthalmia neonatorum.