Abstract: . . .  some countries but is not available in the United States. Silver nitrate causes more chemical conjunctivitis than other agents but is recommended in areas where the incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) is appreciable. Infants born to women with untreated gonococcal infection should also be treated with systemic antibiotics: 1 dose of ceftriaxone (25-50 mg/kg) or cefotaxime (100 mg/kg), as well as topical prophylaxis. Infants who have gonococcal ophthalmia should be evaluated for signs of disseminated infection. Chlamydial Ophthalmia Neonatal ophthalmia due to Chlamydia trachomatis is common. Studies on the efficacy in preventing conjunctivitis (or nasopharyngeal colonization and pneumonia risk) have yielded conflicting results for erythromycin, tetracycline ointment and silver nitrate. Infants with ophthalmia neonatorum caused by C trachomatis should be evaluated and treated. Nongonococcal Nonchlamydial Ophthalmia Silver nitrate, povidone-iodine, and, probably, erythromycin are effective for preventing nongonococcal nonchlamydial conjunctivitis during the first 2 weeks of life. Page 4 Louisiana Office of Public Health – Infectious Disease Epidemiology Section- Infectious Disease Control Manual Administration of Neonatal Ophthalmic Prophylaxis for Gonorrhea (Red Book 2003) Before administering local prophylaxis, each eyelid should be wiped gently with sterile cotton. Two drops of a 1% silver nitrate solution or a 1-cm ribbon of antibiotic ointment (0.5% erythromycin or 1% tetracycline) are placed in each lower conjunctival sac. The eyelids should then be massaged gently to spread the solution or ointment. After 1 minute, excess solution or ointment may be wiped away with sterile cotton. None of the prophylactic agents should be flushed from the eyes after instillation since flushing may reduce the efficacy of prophylaxis. Infants born by cesarean section should receive prophylaxis against neonatal gonococcal ophthalmia. Although gonococcal and chlamydial infections usually are transmitted to the infant during passage through the birth canal, infection by the ascending route also occurs. . . .
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