Prophylaxis for Gonococcal and Chlamydial Ophthalmia Neonatorum (1992)

Prenatal screening for gonorrheal and chlamydial infections, particularly among high risk women, should play a major role in the prevention of ophthalmia neonatorum.
There is good evidence to support the use of universal ocular prophylaxis for gonococcal ophthalmia, at least in the absence of universal prenatal screening for gonorrhea. Prophylaxis should be administered as soon as possible (within 1 hour) after birth; 1% silver nitrate solution, 1% tetracycline ointment, and 0.5% erythromycin ointment are approximately comparable in efficacy.
The occurrence of transient chemical conjunctivitis in some infants after silver nitrate prophylaxis is a minor disadvantage. The risk can be reduced to some degree through the use of single-dose ampoules. Alternatively, tetracycline or erythromycin ointment can be used. Additional considerations in choosing a prophylactic agent are individual preference, cost, and the theoretic possibility that chemical conjunctivitis due to silver nitrate prophylaxis might adversely affect parent-infant bonding.
There is poor evidence to support the use of neonatal ocular prophylaxis with any agent for chlamydia ophthalmia neonatorum.