Severe Ocular Reactions After Neonatal Ocular Prophylaxis With Gentamicin Ophthalmic Ointment

Nathawad, Rita; Mendez, Hermann; Ahmad, Asma; Laungani, Sheila; Hoa, Bich-Trang; Garlick, Jeremy; Hammerschlag, Margaret R.

doi:10.1097/inf.0b013e3181f6c2e5

Cited by 16 publications

(5 citation statements)

References 8 publications

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“…Silver nitrate and tetracycline ophthalmic ointments are no longer manufactured in the United States, bacitracin is ineffective, and povidone iodine has not been studied adequately ( 905 , 906 ). Gentamicin ophthalmic ointment has been associated with severe ocular reactions ( 907 , 908 ). If erythromycin ointment is unavailable, infants at risk for exposure to N. gonorrhoeae, especially those born to a mother at risk for gonococcal infection or with no prenatal care, can be administered ceftriaxone 25–50 mg/kg body weight IV or IM, not to exceed 250 mg in a single dose.…”

Section: Gonococcal Infectionsmentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,726

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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Section: Gonococcal Infectionsmentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,726

2,621

View full text Add to dashboard Cite

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“…Topical gentamicin (cream, ointment, eye and ear drops) has been previously linked to periocular ACD. 13 In a randomized controlled trial comparing effectiveness of topical gentamicin sulfate 0.1% cream and mupirocin 2% cream, only minor exit site irritations developed in 10.5% of patients in both treatment arms with no reported cases requiring discontinuation of antimicrobial preparations. 6 ACD is a cell-mediated type 4 delayed hypersensitivity reaction.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Rash at Peritoneal Dialysis Exit Site

Gosmanova

Ezumba

Fisher

et al. 2015

Journal of Investigative Medicine High Impact Case Reports

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The International Society for Peritoneal Dialysis recommends the regular application of topical antibiotic-containing preparations in addition to a routine exit site care to reduce the risk of exit site infection (ESI). Among these prophylactic antimicrobial preparations, topical gentamicin is one of the widely used and effective antibiotics for prevention of ESI and peritonitis in peritoneal dialysis (PD) patients. Overall, topical gentamicin is well tolerated; however, its use can be associated with the development of allergic contact dermatitis (ACD). We describe a first reported case of PD catheter exit site contact ACD due to topical gentamicin mimicking ESI. The patient in this report developed worsening violaceous in color and pruritic rash surrounding the PD catheter exit site that appeared 3 weeks after the initiation of gentamicin cream. The association between development of rash and initiation of topical gentamicin led to a suspicion of local reaction to gentamicin rather than ESI. Skin biopsy confirmed ACD. Discontinuation of the provoking agent and subsequent treatment with topical hydrocortisone application led to a resolution of the exit site rash. Any rash at a PD catheter exit site should be considered infectious until proven otherwise. However, it is important to be aware of noninfectious etiologies of exit site rashes as the treatment of these 2 conditions differs.

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“…(15) Gentamicin ointment was used for newborn ocular prophylaxis during a shortage of erythromycin ointment in the United States in 2009, but resulted in reports of severe ocular reactions. (16,17) Other ophthalmic antibiotic preparations have not been evaluated in newborns. Therefore, it is questionable whether universal ocular prophylaxis for neonatal gonococcal ophthalmia remains an effective option in Canada.…”

Section: La Prévention De La Conjonctivite Néonatalementioning

confidence: 99%

Preventing Ophthalmia Neonatorum

Moore

MacDonald

2015

Canadian Journal of Infectious Diseases and Medical Microbiolog

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The use of silver nitrate as prophylaxis for neonatal ophthalmia was instituted in the late 1800s to prevent the devastating effects of neonatal ocular infection withNeisseria gonorrhoeae. At that time – during the preantibiotic era – many countries made such prophylaxis mandatory by law. Today, neonatal gonococcal ophthalmia is rare in Canada, but ocular prophylaxis for this condition remains mandatory in some provinces/ territories. Silver nitrate drops are no longer available and erythromycin, the only ophthalmic antibiotic eye ointment currently available for use in newborns, is of questionable efficacy. Ocular prophylaxis is not effective in preventing chlamydial conjunctivitis. Applying medication to the eyes of newborns may result in mild eye irritation and has been perceived by some parents as interfering with mother-infant bonding. Physicians caring for newborns should advocate for rescinding mandatory ocular prophylaxis laws. More effective means of preventing ophthalmia neonatorum include screening all pregnant women for gonorrhea and chlamydia infection, and treatment and follow-up of those found to be infected. Mothers who were not screened should be tested at delivery. Infants of mothers with untreated gonococcal infection at delivery should receive ceftriaxone. Infants exposed to chlamydia at delivery should be followed closely for signs of infection.

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Severe Ocular Reactions After Neonatal Ocular Prophylaxis With Gentamicin Ophthalmic Ointment

Cited by 16 publications

References 8 publications

Sexually Transmitted Infections Treatment Guidelines, 2021

Sexually Transmitted Infections Treatment Guidelines, 2021

A Case Report of Rash at Peritoneal Dialysis Exit Site

Preventing Ophthalmia Neonatorum

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