A Comparison of Silver Nitrate with Erythromycin for Prophylaxis Against Ophthalmia Neonatorum

Abstract

Although prophylactic eyedrops to treat ophthalmia neonatorum is mandated nationwide, states and hospitals are free to choose specific drugs. To compare two of these agents, we studied the incidence and characteristics of ophthalmia neonatorum in two UCLA teaching hospitals over a five-year period. One, which used 1% silver nitrate solution exclusively, had 50 cases in 34,772 births, a frequency of 0.14%. The other used 0.5% erythromycin ointment exclusively and had 43 cases in 12,652 births, a frequency of 0.34%. Ophthalmia neonatorum was more frequent in the hospital using erythromycin (p less than 0.001), as was chlamydial conjunctivitis (p less than 0.02). Although not statistically significant, gonococcal conjunctivitis was found in four infants, all in the hospital using silver nitrate. Because silver nitrate was found more effective in decreasing the total frequency of all cases of ophthalmia neonatorum, and cases caused by Chlamydia and gram-negative bacteria specifically, this drug still should be considered as a primary prophylactic agent against ophthalmia neonatorum.

A chronological study of the bacterial pathogen changes in acute neonatal bacterial conjunctivitis in southern China

“…These two pathogens were previously considered to be opportunistic; however, their existence was increasingly reported recently [ 5 ]. Our finding that Neisseria gonorrhoeae has become the main Gram-negative pathogen in neonatal acute bacterial conjunctivitis is consistent with an increased incidence of neonatal acute gonococcal conjunctivitis due to the rising incidence of gonorrhea in the last 15 years [ 6 – 9 ].…”

A Controlled Trial of Povidone–Iodine as Prophylaxis against Ophthalmia Neonatorum

“…17 Ophthalmia neonatorum has occurred after the use of silver nitrate. 18,19 In addition, silver nitrate causes a serious toxic conjunctivitis, which may impede infant-mother bonding, 20 far more frequently than erythromycin or povidone-iodine. 7 The second reason to study povidone-iodine as prophylaxis against ophthalmia neonatorum is that its antibacterial spectrum exceeds that of any of the other agents.…”

Modulation of Corneal Heme Oxygenase Expression by Oxidative Stress Agents

“…We were particularly interested in silver, which has previously been administered to the eyes of newborn infants in substantial quantities (1% AgN03 «59mM) (23,24) and gold which has anti-inflammatory properties (25)(26)(27). RCE cells were incubated with lOOuM concentrations of a number of heavy metal compounds for 24 hours and then assayed for heme oxygenase activity.…”