Erythromycin ophthalmic ointment

Erythromycin ophthalmic ointment is the medication of choice to prevent ophthalmia neonatorum (blindness caused by a gonorrhea infeetion acquired when passing through the birth canal or coming into contact with the mother s tissues). Because the client has had no prenatal care, this would be recommended procedure in case the infant has been exposed to gonorrhea. 

The client is diagnosed with acute bacterial conjunctivitis. Tbe bealtb-care provider prescribed erythromycin ophthalmic ointment. Which information should the nurse discuss with the client ... 

Treatment of gonorrhea during pregnancy is essential to prevent ophthalmia neonatorum. The CDC recommends that either tetracycline (1%) ophthalmic ointment or erythromycin (0.5%) ophthalmic ointment be instilled in each conjunctival sac immediately postpartum to prevent ophthalmia neonatorum. 

Infants born to mothers with gonococcal Erythromycin (0.5%) ophthalmic ointment in a single application0 or infection (prophylaxis) Tetracycline (l%) ophthalmic ointment in a single application0... 

For prophylaxis of ophthalmia neonatorum, various groups have proposed the use of erythromycin (0.5%) or tetracycline (1%) ophthalmic ointment in lieu of silver nitrate. Although silver nitrate and antibiotic ointments are effective against gonococcal ophthalmia neonatorum, silver nitrate is not effective for chlamydial disease and may cause a chemical conjunctivitis. 

A fixed-combination ointment containing oxytetracy-cline and polymyxin B is available for topical ocular use (see Table 11-6). The Centers for Disease Control and Prevention recommends ophthalmic ointments containing a tetracycline or erythromycin as an effective alternative to silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum. A major advantage of using an antibiotic ointment such as oxytetracycline-polymyxin B is that it does not canse the chemical conjunctivitis typically produced by silver nitrate. 

The clinical significance and incidence of chemical conjunctivitis due to silver nitrate has been investigated in 1000 newborn infants (27). Rinsing after instillation does not reduce the conjunctival irritation. Although 90% of the infants had conjunctivitis in the first 6 hours of life, in most cases it cleared within 24 hours. Chemical conjunctivitis did not increase the incidence of secondary infections. In 1980 the American Academy of Pediatrics pointed out the need for continued prophylaxis for all newborn infants, and proposed a 1% silver nitrate solution in single dose ampules or single-use tubes of an ophthalmic ointment with 1% tetracycline or 0.5% erythromycin. However, in infants of mothers with clinically apparent gonorrhea aqueous crystalhne penicillin G should be injected. 

Topical corticosteroids are used in cases of exacerbation and should be applied sparingly to the affected area. Hydrocortisone 1% twice a day or dexamethasone 0.1% applied to the periorbital area helps to relieve symptoms during these periods. Secondary infection manifested as blepharitis or keratoconjimctivitis should be treated with topical ophthalmic antibiotic ointments such as bacitracin or erythromycin.Topical antihistamines, NSAIDs, or mast cell stabilizers can be used to control itching, and topical steroids are sometimes required to treat severe keratoconjunctivitis associated with the atopic response. Because of side effects, steroids are not indicated for longterm use. 

The active substance is dispersed in the ointment base. The first ointment t3q>e is applicable for only a few active substances dissolved in the non-aqueous ointment bases. To date, almost only paraffin-based lipophilic ointments are used for semisolid ophthalmic products. An example of this type of preparation is eye ointment with 0.5 % erythromycin (Table 10.13). Suitable triglyceride-based vehicles may lead to more solution-type eye ointments (see Sect. 10.7.3). 

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