Ocular prophylaxis for gonococcal ophthalmia neonatorum recommended for all newborns

This recommendation statement by the U.S. Preventive Services Task Force reaffirms the need for ocular prophylaxis of newborns with 0.5% erythromycin ophthalmic ointment. The recommendation is classified as Grade A, suggesting a high certainty of substantial net benefit.

Study design

The authors performed a targeted review of evidence relating to use of topical ocular prophylaxis for gonococcal ophthalmia neonatorum and related ocular conditions.

Outcomes

The USPSTF found that topical ocular prophylaxis of all newborns is effective and not associated with serious harm such as antimicrobial resistance to treatment medication, which reaffirms the 2011 recommendations. Based on these findings, USPSTF concludes that the net benefits of ocular prophylaxis continue to be well established. Therefore, the task force reaffirms its prior recommendation that the benefits of prophylaxis substantially outweigh the potential harm.

Limitations

The only available drug approved by the FDA for the prevention of gonococcal ophthalmia neonatorum is 0.5% erythromycin ophthalmic ointment. In view of increased antimicrobial resistance noted in other countries, further research is needed to find safe and effective alternatives to erythromycin. One excellent alternative would be povidone-iodine. The current review includes limited evidence regarding povidone-iodine usage for ocular prophylaxis for ophthalmia neonatorum and currently it is not approved for use in the United States. More randomized controlled trials are needed to ascertain its safety and efficacy in prevention of ophthalmia neonatorum.

Clinical significance

The rate of gonococcal ophthalmia neonatorum in the United States is low (0.4 cases per 100,000 live births per year), but these infections are on the rise and are likely underreported due to poor antenatal care. Moreover, untreated gonococcal ophthalmia neonatorum can take a rapid and serious course, potentially causing blindness due to corneal scarring or corneal perforation. These factors reaffirm the USPSTF’s previous recommendations of universal ocular prophylaxis of newborns with erythromycin ophthalmic ointment.