Conjunctivitis due to Neisseria gonorrhoeae and/or Chlamydia trachomatis in neonates born to mothers with genital gonococcal and/or chlamydial infections at the time of delivery.
Neonatal conjunctivitis is a medical emergency. Without prompt treatment, risk of corneal lesions and visual impairment.
Clinical features
- Unilateral or bilateral purulent conjunctivitis in the first 28 days of life.
Treatment
- Clean eyes with isotonic sterile solution (0.9% sodium chloride or Ringer lactate) 4 times daily to remove secretions.
- Antibiotic treatment:
- for all neonates with conjunctivitis in the first 28 days of life
- for all neonates born to mothers with a genital infection (purulent cervical discharge) at the time of delivery
|
0 to 7 days |
8 to 28 days |
---|---|---|
First line
|
ceftriaxone IM: 50 mg/kg single dose (max. 125 mg)
|
ceftriaxone IM: 50 mg/kg single dose |
Alternatives |
If ceftriaxone contra-indicated: |
If azithromycin unavailable: |
If symptoms persist 48 hours after parenteral treatment alone, administer azithromycin PO (or erythromycin PO as above).
Notes:
- When systemic treatment is not immediately available, clean both eyes and apply 1% tetracycline eye ointment every hour, until systemic treatment is available.
- In all cases, treat the genital infection of the mother and partner (see Genital infections, Chapter 9).
- Azithromycin and erythromycin are associated with an increased risk of pyloric stenosis in neonates. The risk is higher with erythromycin
[1]
Citation
1.
Lund M et al. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 2014; 348: g1908.
https://www.bmj.com/content/348/bmj.g1908 [Accessed 16 April 2021] [2] Citation 2. Murchison L et al. Post-natal erythromycin exposure and risk of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Pediatr Surg Int. 2016 Dec; 32(12): 1147-1152.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106491/ [Accessed 16 April 2021] [3] Citation 3. Almaramhy HH et al. The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Ital J Pediatr. 2019 Feb 4; 45(1)20.
https://ijponline.biomedcentral.com/articles/10.1186/s13052-019-0613-2 [Accessed 16 April 2021] . Adverse effects should be monitored.
Prevention
Apply as soon as possible and preferably within one hour after birth:
1% tetracycline eye ointment: application of 1 cm in each eye.
- 1.Lund M et al. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 2014; 348: g1908.
https://www.bmj.com/content/348/bmj.g1908 [Accessed 16 April 2021] - 2.Murchison L et al. Post-natal erythromycin exposure and risk of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Pediatr Surg Int. 2016 Dec; 32(12): 1147-1152.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106491/ [Accessed 16 April 2021] - 3.Almaramhy HH et al. The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Ital J Pediatr. 2019 Feb 4; 45(1)20.
https://ijponline.biomedcentral.com/articles/10.1186/s13052-019-0613-2 [Accessed 16 April 2021]