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Erythromycin eye ointment is used on newborns shortly after birth to prevent chlamydial or gonorrheal infection in the baby's eyes.

In many states, this is required by law regardless of whether the mother actually has chlamydia or gonorrhea or not. What is the logic here? Does this law make sense medically?

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  • Hmm... good question but the problem is you're asking for the legislature's reasoning, not medical reasoning, and those things often don't agree. That puts your question into the realm of law and politics. The better question would be do current medical guidelines agree with these laws?
    – Carey Gregory ♦
    May 15, 2022 at 4:36
  • How is this different from mandating vaccines? There’s no guarantee that a person will be exposed to, say, measles, mumps, or rubella, so why are they given? If it prevents one child from going blind, isn’t it worth it?
    – anongoodnurse
    May 20, 2022 at 0:22
  • @anongoodnurse If the mother doesn't have gonorrhea, what exactly is the point? It's not that there is a chance there will be no exposure, it's guaranteed.
    – Ryan_L
    May 20, 2022 at 1:20
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    How do you know the mother doesn’t have gonorrhea? Because of a negative test result weeks earlier? A lot can happen in that time. Also, a gonorrhea test is probably at least $100 and erythromycin ointment is less than $1.
    – Ian Campbell ♦
    May 20, 2022 at 10:55
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    Exactly what @IanCampbell said. There are no guarantees, and not to cast aspersions, but the mother would not be the first person in history to deny extramarital sex. A quarter-inch of erythromycin ophthalmic ointment is cheaper and quicker than a test for gonorrhea, which may take a while to come back. My own kids got the ophthalmic ointment, and in no way was I offended/other, it’s so incredibly unlikely to hurt the infant in any way.
    – anongoodnurse
    May 20, 2022 at 16:19

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The American Academy of Pediatrics (AAP) continues to recommend prophylaxis for all infants:

If gonorrhea is prevalent in the region and prenatal treatment cannot be ensured, or where required by law, a prophylactic agent of 0.5% erythromycin ointment should be instilled into the eyes of all newborn infants (including those born by cesarean delivery) to prevent sight-threatening gonococcal ophthalmia.

Likewise, the United States Preventative Services Taskforce recommends routine prophylaxis as a Grade A recommendation:

Benefits of Preventive Medication

The USPSTF found convincing evidence that ocular prophylaxis of newborns with 0.5% erythromycin ophthalmic ointment can prevent gonococcal ophthalmia neonatorum.

Harms of Preventive Medication

The USPSTF found convincing evidence that ocular prophylaxis of newborns with 0.5% erythromycin ophthalmic ointment is not associated with serious harms.

Thus, according to the US agency responsible for evidence-based medical guidelines, the benefits outweigh the risk. (As an aside, I take their recommendations very seriously, both for my own healthcare, and that of my patients.)

However, like you, the AAP questions the need for the legal requirement:

Because prophylaxis with topical antimicrobial agents is highly effective in preventing blindness from gonococcal neonatal ophthalmia, it has been mandated by law in many jurisdictions. ... The necessity for mandatory eye prophylaxis in this country has been questioned, primarily because rates of intrapartum exposure to gonorrhea have been greatly reduced by prenatal screening and treatment of maternal disease. ... The American Academy of Pediatrics supports reevaluation of the continued necessity of legislative mandates in the United States for universal neonatal eye prophylaxis, and advocates for legislation that allows adoption of alternative strategies...

See the full chapter for additional discussion.

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