Eyemycin Shortage: What Providers and Prescribers Need to Know in 2026

The shortage of erythromycin ophthalmic ointment 0.5% (formerly marketed as Eyemycin, currently available only as generic from Bausch & Lomb) has been one of the most persistent and clinically impactful drug supply issues in ophthalmology over the past decade. This briefing summarizes the current supply landscape, clinical implications, evidence-based prescribing alternatives, and tools for helping your patients access this critical medication in 2026.

Current Supply Status (2026)

As of early 2026, erythromycin ophthalmic ointment is available in limited quantities from Bausch & Lomb — the sole remaining major commercial manufacturer in the United States. Key supply chain facts:

Akorn Inc. ceased all pharmaceutical operations in February 2023.

Padagis discontinued all erythromycin ophthalmic ointment presentations in August 2023.

Bausch & Lomb distributes both 1g unit-dose tubes (NDC 24208-0910-19) and 3.5g tubes (NDC 24208-0910-55). The ASHP has reported back-order episodes for both presentations.

New York State's DOH issued a Dear CEO/Colleague letter in February 2026 reaffirming the ongoing shortage and providing updated alternative protocols for neonatal care.

Availability is intermittent and regionally variable. Retail pharmacies are most affected; hospital formulary procurement may have more consistent access through direct manufacturer contracts.

Clinical Significance: Why This Shortage Matters Most for Neonates

Erythromycin ophthalmic ointment is the only FDA-approved ointment commercially available in the U.S. for prophylaxis of ophthalmia neonatorum due to N. gonorrhoeae and C. trachomatis. The two historically available alternatives — 1% tetracycline ophthalmic ointment and 1% silver nitrate — are no longer commercially available in the United States. This places erythromycin in a uniquely critical position: there is no equivalent ointment substitute for neonatal prophylaxis.

Gonococcal ophthalmia neonatorum, without prophylaxis or treatment, can cause corneal scarring, perforation, and permanent blindness within 24 hours of birth. Transmission risk from an untreated gonococcal-positive mother ranges from 30–50%. Universal prophylaxis is mandated in most U.S. states, including New York (10 NYCRR § 12.2).

Evidence-Based Prescribing Alternatives for Non-Neonatal Patients

During shortage periods, the FDA, CDC, AAO, and ASCRS have recommended that clinicians transition non-neonatal patients to alternative agents, preserving limited supply for newborn use. Clinically appropriate alternatives include:

Azithromycin 1% ophthalmic solution (AzaSite): Recommended by FDA, CDC, AAO, and ASCRS as the primary alternative for superficial ocular infections. Broader spectrum than erythromycin, higher tissue penetration, favorable pharmacodynamics. Dosing: 1 drop BID × 2 days, then 1 drop QD × 5 days. Note: AzaSite is itself in shortage as of 2026.

Tobramycin 0.3% ophthalmic solution/ointment: Broad-spectrum aminoglycoside; preferred when gram-negative coverage is needed. Generally well-stocked. Dosing: 1-2 drops q4h (or q1-2h for severe infections).

Bacitracin ophthalmic ointment: Bactericidal, gram-positive focus; lower systemic resistance pressure due to no oral form. Note: Ophthalmic bacitracin itself has experienced shortage episodes in 2025–2026.

Fluoroquinolones (ciprofloxacin 0.3%, moxifloxacin 0.5%, ofloxacin 0.3%, levofloxacin 0.5%): Broad spectrum; appropriate for moderate-to-severe infections, contact lens wearers, and suspected Pseudomonas. Generic ciprofloxacin and ofloxacin ophthalmic are inexpensive and widely available.

Neonatal Prophylaxis Protocols During Shortage

When erythromycin ointment is unavailable, the CDC and AAP recommend:

Test birthing parents at risk for N. gonorrhoeae using NAAT in the immediate peripartum setting.

If the test is positive or pending with concerns about follow-up: administer ceftriaxone 25–50 mg/kg IV or IM (max single dose 250 mg) to the neonate.

Document any instances of erythromycin ointment shortage and notify local health departments of procurement challenges.

Resistance Considerations

Clinicians should be aware that erythromycin resistance among ocular isolates of Staphylococcus species has been extensively documented. Some studies have reported resistance rates as high as 70% among S. aureus ocular isolates. This has already driven a shift in many ophthalmic practices toward tobramycin and fluoroquinolones for suspected staphylococcal conjunctivitis and blepharitis, even independent of the supply shortage.

Helping Your Patients Access Erythromycin When Available

When erythromycin ophthalmic ointment is specifically indicated and you want to help patients find it, medfinder for Providers can check real-time pharmacy availability near your patient before you send the prescription — reducing call-back volume and patient frustration.

Prescribing Recommendations Summary

Write prescriptions generically as 'erythromycin ophthalmic ointment 0.5%' (not Eyemycin — that brand is discontinued)

For non-neonatal patients: transition to tobramycin, azithromycin, or fluoroquinolones depending on indication and infection severity

For hospital-based neonatal teams: maintain adequate stock of erythromycin and have ceftriaxone protocols in place

Monitor ASHP and FDA drug shortage databases for updated availability information

For a provider-focused guide to helping patients locate available stock, see our article: How to Help Your Patients Find Eyemycin in Stock: A Provider's Guide.