Neonatal conjunctivitis

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    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
    (max. 125 mg)
    +
    azithromycin PO: 20 mg/kg once daily for
    3 days

    Alternatives

    If ceftriaxone contra-indicated:
    cefotaxime IM: 100 mg/kg single dose

    If azithromycin unavailable:
    erythromycin PO: 12.5 mg/kg 4 times daily for 14 days

     

    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.

     

    References
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