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CDC Updates Guidance on Ophthalmia Neonatorum Prophylaxis. With Erythromycin Ophthalmic Ointment in Short Supply, Agency Offers Alternatives
American Family Physician, 09/11/09

The agency said Sept. 4 that azithromycin ophthalmic solution (1%), which is marketed by Inspire Pharmaceuticals as AzaSite, is an acceptable substitute if erythromycin ophthalmic ointment (0.5%). The recommended dose of azithromycin ophthalmic solution (1%) is one or two drops in the conjunctival sac of each eye, taking care to not touch the infant with the applicator tip. Because this is a solution rather than an ointment, it is important to assure that drops are placed properly: consider a two–person administration approach – one (person) to hold the eye lids open and the other to administer the medication. Prophylaxis is recommended whether the infant is delivered vaginally or by cesarean section.

If neither azithromycin ophthalmic solution (1%) nor erythromycin ophthalmic ointment (0.5%) is available, the CDC advised that gentamicin ophthalmic ointment (0.3%) and tobramycin opththalmic ointment (0.3%) are acceptable alternatives. Both products are marketed under various brand names and also are available as generic products.

If none of the aforementioned products is available, ciprofloxacin ophthalmic ointment (0.3%), marketed as Ciloxan by Alcon Laboratories, can be used – this product is a less suitable alternative because of possible gonococcal antimicrobial resistance.

Physicians should be alert to the possibility of failure of prophylaxis – infants treated with any of these prophylactic alternatives should be examined closely for ophthalmia neonatorum within 48 to 72 hours after being discharged from the hospital.

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