Neonatal conjunctivitis


– 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.
– Antibiotherapy:
• 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 

 Age

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).

Prevention

Apply as soon as possible and preferably within one hour after birth:
1% tetracycline eye ointment: application of 1 cm in each eye.