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Use prophylactic antibiotic eye ointment in all newborns for gonococcal infection: USPSTF


Use prophylactic antibiotic eye ointment in all newborns for gonococcal infection: USPSTF

The U.S. Preventive Services Task Force (USPSTF) reaffirms its recommendation for the use of an antibiotic ointment to prevent gonococcal eye infections in all newborns, a gonorrhoea infection that is transmitted from the mother to the newborn during delivery.

In the United States, the rate of gonococcal ophthalmia neonatorum was an estimated 0.4 cases per 100 000 live births per year from 2013 to 2017.1-4 Gonococcal ophthalmia neonatorum can cause corneal scarring, ocular perforation, and blindness as early as 24 hours after birth. In the absence of ocular prophylaxis, transmission rates of gonococcal infection from mother to newborn are 30% to 50%.

The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. This latest statement is a reaffirmation of its 2011 recommendation on prevention of gonococcal ophthalmia neonatorum, a gonorrhea infection of the eye in newborns. This infection can spread to the cornea and cause blindness as early as 24 hours after birth. In the absence of prevention, transmission rates of gonococcal infection from mother to newborn are 30 percent to 50 percent.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum.The USPSTF found convincing evidence that ocular prophylaxis of newborns with 0.5% erythromycin ophthalmic ointment can prevent gonococcal ophthalmia neonatorum.The USPSTF found convincing evidence that ocular prophylaxis of newborns with 0.5% erythromycin ophthalmic ointment is not associated with serious harms.

The rates of gonococcal ophthalmia neonatorum are related to gonococcal infection rates in women of reproductive age. Accordingly, screening for and treatment of gonococcal infection in pregnant women is an important strategy for reducing the sexual transmission of gonorrhea and subsequent vertical transmission leading to gonococcal ophthalmia neonatorum. While screening and treatment programs have reduced the rates of gonorrhea in pregnant women, there are large disparities in access to prenatal care in the United States. Risk-based prophylaxis has also been proposed as an alternative strategy for preventing gonococcal ophthalmia neonatorum. Currently, there are no risk-based tools for screening pregnant women and no studies examining the use of risk-based vs universal prophylaxis. Therefore, ocular prophylaxis remains an important tool in the prevention of gonococcal ophthalmia neonatorum.

For more details click on the link: doi:10.1001/jama.2018.21367


Source: self

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