Shortage of Only Eye Ointment to Protect Newborns from Gonorrhea-related Eye Infections Requires Alternative Options

Most infants born in the U.S. are given an antibiotic eye ointment soon after delivery. This prevents a potentially serious eye infection that can be caused by chlamydia, gonorrhea, or other bacteria transmitted from parent-to-infant during birth.

Unfortunately, there is currently a shortage of erythromycin 0.5% ophthalmic ointment, which is the only regimen recommended for this use. With no end of the shortage in sight, the Centers for Disease Control and Prevention (CDC) recently released recommendations for health care providers and hospitals that are unable to get this medication.

These alternatives include another ointment that could be used and treating infants who may have been exposed to chlamydia and gonorrhea during birth, but the agency stresses the importance of pre-natal STI testing for pregnant people. This is the best way to protect both them and their infants from potential long-term consequences.

Infants exposed to bacteria like chlamydia and gonorrhea during birth can get ophthalmia neonatorum or neonatal conjunctivitis. This can cause red, swollen, and goopy eyes. If not treated, it can lead to inflammation of the iris (the colored part of the eyes), a scar or hole in the cornea, or blindness.

Treating all infants as a precaution is important. Without it, an infant born to a mother who has gonorrhea, for example, has a 30% to 50% chance of getting infected.

The shortage of erythromycin eye ointment has been going on since 2022, because multiple pharmaceutical companies have stopped making it or decreased their production. To help alleviate the shortage, the FDA has temporarily approved a similar formula manufactured by a Canadian company for sale in the United States.

The CDC says that any provider who has access to erythromycin ophthalmic ointment (0.5%) should continue to use it. It then offers three alternative prevention options for those who can’t find it.

• Option one is a different prophylactic eye drop called azithromycin ophthalmic solution 1%. This is not ideal because this medication is more expensive and has not yet been proven to prevent ophthalmia neonatorum. That said, the CDC believes it will work based on available pharmacology data, limited prior use, and expert opinion.
  
  
• The second option involves testing all birthing parents for gonorrhea and chlamydia at the time of delivery and providing treatment to parents and infants who test positive.
  
  
• Option three calls for treating those infants born to parents at higher risk of gonorrhea. This includes parents who did have prenatal care, those with a history of STIs during pregnancy, and those with a history of substance use.

With options two and three, babies would be treated with an injection of antibiotics (either ceftriaxone or cefotaxime).

It’s important that providers understand these alternatives, but the CDC stresses that the best way to prevent chlamydia and gonorrhea infections in newborns is to screen all pregnant people for these STIs early in the pregnancy and again in later months. Anyone who tests positive can be treated before they give birth to avoid the risk of parent-to-child transmission.