Compared with silver nitrate, erythromycin or tetracycline prophylaxis did not reduce the incidence of chlamydial conjunctivitis in infants born to mothers with Chlamydia trachomatis infection, according to a literature review published in BMC Infectious Diseases. These findings highlight that routine prenatal screening and treatment of pregnant women may be the best method for preventing neonatal chlamydial conjunctivitis.

In order to determine if antibiotic prophylaxis is effective in preventing neonatal chlamydial conjunctivitis, the authors conducted a literature search using MEDLINE and EMBASE databases. Studies were included based on the following criteria: the studies were prospective or comparative in nature; pregnant women were screened for C trachomatis; and there was follow-up of infants born to mothers with C trachomatis, with follow-up occurring at regular intervals along with testing for C trachomatis regardless of symptoms and including administration of antibiotic prophylaxis.

Of the 159 studies, 11 were selected for review and 3 met the inclusion criteria. All 3 studies were published in the 1980s, and each compared the incidence of C trachomatis ophthalmia neonatorum with either erythromycin or tetracycline vs silver nitrate.

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The earliest published article by Hammerschlag et al in 1980 showed that erythromycin was more effective than silver nitrate (odds ratio [OR], 0.06; 95% CI, 0.00-0.33; P =.002). Because the sample size of the 1980 study was small (N=60), Hammerschlag et al conducted a larger study in 1989 (N=230). This larger study, however, failed to replicate the initial findings. In fact, when compared with silver nitrate, neither erythromycin (OR, 0.56; 95% CI, 0.23-1.38; P =.206) nor tetracycline (OR, 0.44; 95% CI, 0.14-1.25; P =.104) decreased the incidence of C trachomatis ophthalmia neonatorum.

The third study by Bell et al was published in 1987 and included 120 infants. Like the 1989 study, this study showed that erythromycin was not more effective than silver nitrate (OR, 0.60; 95% CI, 0.14-2.04; P =.436).

Although erythromycin is currently the only available neonatal ocular prophylaxis approved by the US Food and Drug Administration for chlamydial conjunctivitis, the evidence is sparse. As such, “Prenatal screening and treatment of pregnant women is the most effective strategy for prevention of perinatal chlamydial infection,” concluded the authors.


Smith-Norowitz TA, Ukaegbu C, Kohlhoff S, Hammerschlag MR. Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns. BMC Infect Dis. 2021;21(1):270. doi:10.1186/s12879-021-05974-3