University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Is povidone-iodine a superior agent for protecting neonates against ophthalmia neonatorum when compared to standard agents (erythromycin and silver nitrate)?
  
  

Clinical Bottom Lines

1. Povidone-iodine is more efficacious than erythromycin or silver nitrate for prevention of neonatal conjunctivitis, and has less toxicity.
   
2. For all infections NNTs were 48 versus erythromycin and 23 versus silver nitrate.
   
3. In regards to toxicity, NNTs were 28 versus erythromycin and 24 versus silver nitrate.

Summary of Key Evidence

1. A prospective, masked, randomized trial on 3117 neonates at one hospital in Kenya rotated, on a weekly basis, between 2.5% povidone-iodine drops, 0.5% erythromycin ointment, and 1% silver nitrate drops for neonatal ophthalmic prophylaxis.
2. Follow up was by self report of mothers who were taught the symptoms of conjunctivitis. The eyes of these infants were swabbed and sent for culture.
3. Logistic-regression analysis found that use of povidone-iodine led overall to fewer neonatal eye infections, 13.1% (including C. trachomatis, N. gonorrhoeae, S. aureus, coag-negative staphylococci, and Gram-negative bacteria) than silver nitrate (17.5%, P<0.001), and erythromycin (15.2%, P=0.001).
4. Povidone-iodine resulted in fewer cases of non-bacterial conjunctivitis (9.7%) than silver nitrate (13.9%, P<0.001), or erythromycin (13.3%, P=0.004).
   

Additional Comments

• The cost of povidone-iodine in Kenya was 7-fold less than erythromycin and 70-fold less than silver nitrate. This is now used in much of the world and a U.S. trial is pending.2
• Resistance of N. gonorrhoeae to tetracycline has become an increasing problem and could become a problem for erythromycin in the future. However, there are reports showing that there are some strains of staph and pseudomonas that are resistant to povidone-iodine.
• Povidone-iodine has been shown to be effective against viruses, such as HIV and herpes.2,3
  

Citation

1. Isenberg SJ, Apt L, Wood M. A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum. N Engl J Med. 1995; 332(9): 562-6.
2. Isenberg SJ, Apt L, Campeas D. Ocular applications of povidone-iodine. Dermatology. 2002; 204 Suppl 1:92-5.
3. Benevento WJ, Murray P, Reed CA, Pepose JS. The sensitivity of Neisseria gonorrhoeae, Chlamydia trachomatis, and herpes simplex type II to disinfection with povidone-iodine. Am J Ophthalmol. 1990;109(3): 329-33.
   

CAT Author: Jordan Shavit, MD

CAT Appraisers: John Frohna, MD

Date appraised: June 17, 2002