Randomized Trial of Silver Nitrate, Erythromycin, and No Eye Prophylaxis for the Prevention of Conjunctivitis Among Newborns Not at Risk for Gonococcal Ophthalmitis

Abstract

Objective. To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis. Design. Randomized doubly masked clinical trial. Setting. University of Washington Hospital and affiliated clinics, Seattle, between 1985 and 1990. Subjects. The medical records of 8499 women were evaluated for possible participation; 2577 were eligible. Of the 758 enrolled, the infants of 630 were evaluable. Intervention. Comparison of silver nitrate, erythromycin, and no eye prophylaxis given at birth for the prevention of conjunctivitis. Main outcome measures. Conjunctivitis during the first 60 days of life and nasolacrimal duct patency in the first 2 days of life. Results. The frequency of impatent tear ducts at the 30- to 48-hour examination did not differ significantly by prophylaxis group. Among the 630 infants randomized and observed, 109 (17%) developed mild conjunctivitis. Sixty-nine (63%) of the cases appeared during the first 2 weeks of life. After 2 months of observation, infants allocated to silver nitrate eye prophylaxis at birth had a 39% lower rate of conjunctivitis (hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97), and those allocated to erythromycin had a 31% lower rate of conjunctivitis (hazaid ratio = 0.69, 95% confidence interval = 0.44 to 1.07), than did those allocated to no prophylaxis. Conclusion. Silver nitrate eye prophylaxis caused no sustained deleterious effects and even provided some benefit to infants born to women without Neisseria gonorrhoeae. However, the effect was modest and against microorganisms of low virulence. The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.