Bacterial Ophthalmic Infections
Erythromycin is used topically in the treatment of superficial infections of the eye involving the conjunctiva and/or cornea caused by susceptible bacteria.
Chlamydial Ophthalmic Infections
Erythromycin has been used topically in the treatment of trachoma. The most widely used therapy for trachoma is topical treatment with erythromycin, tetracycline (no longer commercially available in the US), or sulfacetamide ointment, or oral erythromycin or a tetracycline. Oral azithromycin also is effective. Systemic anti-infective therapy (e.g., oral erythromycin, azithromycin, doxycycline) is used for the treatment of chlamydial conjunctivitis; data to support use of topical anti-infectives, in conjunction with systemic therapy, are not available.
Infants born to women with untreated chlamydial infection are at high risk for infection; however, prophylaxis is not currently recommended for such infants. Efficacy of topical prophylaxis for the prevention of chlamydial neonatal conjunctivitis has not been established. Chlamydial ophthalmia neonatorum and other chlamydial infections require systemic treatment (e.g., oral erythromycin); topical anti-infective therapy alone is inadequate for the treatment of chlamydial ophthalmia neonatorum and is unnecessary when appropriate systemic anti-infective therapy is given.
Prophylaxis of Gonococcal Ophthalmia Neonatorum
Erythromycin is used topically for prophylaxis of gonococcal ophthalmia neonatorum.
The US Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP) recommend topical prophylaxis against gonococcal ophthalmia neonatorum in all neonates as soon as possible after birth (regardless of whether they are delivered vaginally or by cesarean section), and such prophylaxis is required by law in most states. Although diagnosis and treatment of gonococcal infections in pregnant women is the best means of preventing neonatal gonococcal disease, not all women receive prenatal care. The CDC states that universal topical prophylaxis is warranted since it can prevent sight-threatening gonococcal ophthalmia and because it is safe, easy to administer, and inexpensive.
The CDC and AAP currently recommend use of topical erythromycin, topical tetracycline (no longer commercially available in the US), or topical silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum. Topical erythromycin and topical tetracycline appear to be as effective as 1% silver nitrate topical solution in preventing gonococcal ophthalmia neonatorum and reportedly produce lower incidences of local irritation than 1% silver nitrate topical solution; however, some state or local public health regulations may still require the prophylactic use of silver nitrate rather than other anti-infectives. Topical silver nitrate may be preferred for the prevention of gonococcal ophthalmia neonatorum in areas where the incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) is relatively high.
Infants born to women with untreated gonorrhea are at high risk of infection with N. gonorrhoeae and should receive systemic prophylaxis (e.g., ceftriaxone) in addition to the usual topical prophylaxis. If gonococcal ophthalmia is diagnosed in the neonate, systemic therapy (e.g., ceftriaxone) is necessary; topical anti-infective therapy alone is inadequate for the treatment of gonococcal ophthalmia and is unnecessary when appropriate systemic anti-infective therapy is given.
For systemic use of erythromycin, see the Erythromycins General Statement 8:12.12.04. For other topical uses of erythromycin, see Erythromycin 84:04.04.