There is an ongoing shortage of erythromycin ointment. Erythromycin 0.5% ophthalmic ointment is the only recommended regimen to prevent ophthalmia neonatorum caused by N. gonorrhoeae.
If erythromycin ointment is not available, a birthing parent who is at risk for exposure to N. gonorrhoeae * or who had no prenatal care, should be tested for N. gonorrhoeae in the immediate peripartum setting using a nucleic acid amplification test (NAAT). If the birth parent’s test is positive for gonorrheal infection or if the test result is pending at time of discharge with concerns for lack of follow-up, the neonate should receive ceftriaxone, 25 to 50 mg/kg of body weight, IV or IM, not to exceed 250 mg in a single dose; if ceftriaxone is unavailable or contraindicated, a single dose of ceftazidime or cefepime may be substituted.2-4
Due to the ongoing erythromycin ointment shortage, the Centers for Disease Control and Prevention (CDC) recently provided interim guidance for other possible options for the prevention of ophthalmia neonatorum. Please see the CDC webpage on the availability of STI Testing and Treatment Products for additional information.
The CDC recommends notifying your local health department of any challenges in procuring the product. Additional information regarding the availability of erythromycin (0.5%) ophthalmic ointment is available on the FDA Drug Shortage page.
* Women < 25 years old, and those 25 years or older who have a new partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection (STI), or live in a community with high rates of gonorrhea; practice inconsistent condom use when not in a mutually monogamous relationship; have a previous or coexisting STI; have a history of exchanging sex for money or drugs; or have a history of incarceration.1,2
References:
- US Preventive Services Task Force. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. 2021 Sept 14;326(10):949-956
- Sexually Transmitted Infections Treatment Guidelines, 2021. Centers for Disease Control and Prevention. Available at: www.cdc.gov/std/treatment-guidelines/gonorrhea-neonates.htm
- Nolt D, O’Leary ST, Aucott SW; AAP Committee on Infectious Diseases, AAP Committee on Fetus and Newborn. Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices. Pediatrics. 2022;149(2):e2021055554
- American Academy of Pediatrics. Gonococcal Infections. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021:338-344
Resources:
Availability of STI Testing & Treatment Products | Centers for Disease Control and Prevention
STI Treatment Guidelines, 2021 | Centers for Disease Control and Prevention
Erythromycin Ointment Drug Shortage | US Food and Drug Administration
Red Book Online | American Academy of Pediatrics
AAP News | American Academy of Pediatrics
