A meta-analysis of the efficacy of ocular prophylactic agents used for the prevention of gonococcal and chlamydial ophthalmia neonatorum

Abstract

Introduction: Neonatal eye prophylaxis has been routine in North America for more than a century. Contextual changes justify reexamining this practice, and prompted a systematic review of the efficacy of prophylactic agents.

Methods: We searched MEDLINE (1966-2008), EMBASE (1980-2008), CINAHL (1982-2008), and the Cochrane library (the first quarter of 2008) for relevant clinical trials and hand-searched the resulting reference lists. We independently evaluated eligibility and study quality. Meta-analyses were performed using a random effects model.

Results: Each of the eight included studies had substantial methodologic weaknesses. Data to estimate the efficacy of prophylaxis in the prevention of gonococcal ophthalmia neonatorum (GON) were not available. One study found no differences in rates of chlamydial ophthalmia neonatorum (CON) when three agents were compared to no prophylaxis: silver nitrate (relative risk [RR] = 1.06; 95% confidence interval [CI], 0.55-2.02; 2225 newborns), erythromycin (RR = 0.93; 95% CI, 0.48-1.79; 2306 newborns), and tetracycline (RR = 0.82; 95% CI, 0.42-1.63; 2299 newborns). No statistically significant differences were found between agents in the prevention of GON. Erythromycin and povidone-iodine both decrease the risk of CON when compared to silver nitrate (RR = 0.71; 95% CI, 0.52-0.97; 4514 newborns, and RR = 0.52; 95% CI, 0.38-0.71; 2005 newborns, respectively).

Discussion: Failure rates of universal eye prophylaxis support reexamination of this policy where the prevalence of maternal infection is low.