Prophylaxis of Gonococcal and Chlamydial Ophthalmia Neonatorum

Abstract

We evaluated the use of silver nitrate drops and tetracycline ointment for the prophylaxis of ophthalmia neonatorum in a controlled trial involving 2732 newborns in Nairobi, Kenya. The overall rates of prevalence of intrapartum maternal gonococcal and chlamydial infection were 6.4 and 8.9 percent, respectively. After prophylaxis with silver nitrate, the incidence rates of gonococcal, chlamydial, and nongonococcal, nonchlamydial ophthalmia neonatorum were 0.4, 0.7, and 6.2 percent, respectively, whereas after prophylaxis with tetracycline, the rates were 0.1, 0.5, and 4.5 percent. The attack rates of gonococcal ophthalmia neonatorum in newborns exposed to Neisseria gonorrhoeae at birth were 7.0 percent in those receiving silver nitrate and 3.0 percent in those receiving tetracycline (95 percent confidence interval for the difference in rates, -3.4 to 11.4 percent). As compared with historical controls, the incidence of gonococcal ophthalmia neonatorum decreased 83 percent among infants treated with silver nitrate and 93 percent among those treated with tetracycline. Failure of prophylaxis was associated with postpartum maternal endometritis (P = 0.05). Among newborns exposed to maternal infection with Chlamydia trachomatis, chlamydial conjunctivitis developed in 10.1 percent given silver nitrate and in 7.2 percent given tetracycline (95 percent confidence interval for the difference in rates, -4.7 to 10.5 percent), yielding reductions in the incidence of chlamydial ophthalmia of 68 and 77 percent, respectively, as compared with the historical controls. We conclude that tetracycline is as effective as silver nitrate in preventing gonococcal ophthalmia neonatorum.

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…550 In another study, tetracycline ointment was superior to silver-nitrate drops. 541 conclusions. Evidence for the benefit of prophylaxis with silver-nitrate drops, tetracycline ointment, or erythromycin ointment to prevent ophthalmia neonatorum is well established, based largely on developed-country studies.…”

“…539 In developing countries such as Kenya, where rates of maternal STDs are high, rates of gonococcal ophthalmia range from 15% to 34%. 540,541 A variety of interventions have been evaluated for prevention of ophthalmia neonatorum in developed countries, mostly in hospital settings, and have largely focused on the prevention of gonococcal infections. [542][543][544][545] These studies have suggested that silver-nitrate, tetracycline, or erythromycin ointments given prophylactically are equivalent in efficacy.…”

“…Both were undertaken in urban hospital settings. 541,550 In 1 study, povidone-iodine was superior to silver-nitrate drops and to costlier erythromycin ointment. 550 In another study, tetracycline ointment was superior to silver-nitrate drops.…”

“…Incidence of N gonorrhoeae and Staphylococcus aureus infections was similar in the 3 groups. Laga et al 541 Kenya; urban setting; QT 2732 infants were enrolled in 1 of 2 groups to have either 1% silver nitrate (n ϭ 1233) or 1% tetracycline (n ϭ 1499) instilled in their eyes. A historical cohort of newborns who did not receive eye prophylaxis were included as controls.…”

Conjuntivite neonatal com ênfase na sua prevenção

“…No entanto, esses agentes não se mostraram mais eficazes contra a CT que o NP, pelo menos quando utilizados da mesma maneira, ou seja, em aplicação única (12,(49)(50)(51)(52) . Além disso, os antibióticos citados levaram à geração de resistência bacteriana e à consequente ocorrência de epidemias, relacionadas com germes resistentes, como estafilococos (53,54) .…”