From suspicion to action: the chemical conjunctivitis and silver nitrate connexion example in Brazilian hospitals.
BACKGROUND
During the 20th century, silver nitrate (SN) eye drops instillation to newborns had been the best prophylaxis against ophthalmia neonatorum (ON) caused by Neisseria gonorrheae, the most frequent cause of ocular infections leading to blindness. At present, this treatment has been questioned because there is a growing prevalence of other pathogens such as Chlamydia trachomatis, and SN is associated with chemical conjunctivitis (ChC). In addition, SN could present some conservation problems in tropical climates. Among other alternative drugs, 2.5% povidone-iodine has a proven efficacy, not only against Neisseria, but also against Chlamydia, has no conservation problems, has not been associated with ChC and is cheap.


METHODS
The recently created Setor de Farmacovigilãncia (SF) of the São Paulo State in Brazil has created a pharmacovigilance network of 11 big public hospitals. During a periodical signal searching process, the SF found a cluster of 33 ChC reports from one of the network hospitals.


RESULTS
The problem was discussed with the remaining participant hospitals and this signal was used as a way to strengthen the network. Thirteen months later, 622 ChC reports were received from six hospitals.


CONCLUSIONS
Thus, this well-known side-effect in the literature was highlighted as a 'real' problem in Brazil, and some participant hospitals began a discussion period together with the delivery and newborn care professionals in order to switch SN by povidone-iodine. This is an example of both, how a simple pharmacovigilance exercise could improve the implication of health professionals with their own therapeutic problems and how a pharmacovigilance network could be strengthened.
Napchan
Berta-Monica
BM
Setor de Farmacovigilância, Centro de Vigilância Sanitária, Secretaria de Estado da Saúde, São Paulo, Brazil.
Morales
Raquel Pinheiro
RP
Carvalho
Marisa Lima
ML
Cunha
Keliane Vasconcellos
KV
Figueras
Albert
A
D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D001938:Brazil / Q000453:epidemiology; D002690:Chlamydia Infections / Q000517:prevention & control; D002692:Chlamydia trachomatis; D003231:Conjunctivitis / Q000139:chemically induced* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009878:Ophthalmia Neonatorum / Q000517:prevention & control; D009883:Ophthalmic Solutions; D011206:Povidone-Iodine / Q000627:therapeutic use; D011358:Product Surveillance, Postmarketing; D012835:Silver Nitrate / Q000009:adverse effects*
D000891:Anti-Infective Agents, Local; D009883:Ophthalmic Solutions; D011206:Povidone-Iodine; D012835:Silver Nitrate