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Conjunctivitis in The Neonate – Treatment

The currently recommended therapy for neonatal gonococcal conjunctivitis by both the CDC and the WHO is ceftriaxone, 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg.

The currently recommended therapy for neonatal gonococcal conjunctivitis by both the CDC and the WHO is ceftriaxone, 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg. The infant should be hospitalized until the conjunctivitis has resolved which usually occurs within 24–48 hours after treatment with ceftriaxone.

Topical antimicrobial therapy is not beneficial in the presence of systemic treatment. Alternatives for the treatment of gonococcal conjunctivitis when ceftriaxone is not available are cefotaxime 25 mg/kg IM in a single dose or kanamycin 25 mg/kg (maximum 75 mg) IM in a single dose.

Infants born to mothers with untreated gonorrhea at the time of delivery are at high risk of infection and should receive ceftriaxone, 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg. Oral erythromycin suspension (ethylsuccinate or stearate) (50 mg/kg/d for 14 days) is the therapy of choice for the treatment of chlamydial conjunctivitis in infants. It provides better and faster resolution of the conjunctivitis as well as treats any concurrent nasopharyngeal infection.

Additional topical therapy is not needed. The efficacy of this regimen has been reported to range from 80% to 90%; as many as 20% of infants may require another course of therapy. Treatment with oral erythromycin has been associated with infantile hypertrophic pyloric stenosis in infants younger than 6 weeks who were given the drug for prophylaxis after nursery exposure to pertussis.

Data on use of other macrolides, including azithromycin or clarithromycin, for the treatment of neonatal Chlamydia infection are limited. There is one small study that evaluated azithromycin: It found that a short course of azithromycin suspension, 20 mg/ kg/day orally, one dose daily for 3 days, was as effective as 2 weeks of erythromycin in eradication of C. trachomatis from the conjunctivae and nasopharynx of infants with conjunctivitis. Prophylactic treatment of infants born to women with untreated chlamydial infection is not recommended, as optimum dosing and duration of treatment are not known.

Data on treatment of neonatal conjunctivitis caused by other bacteria are limited. Considering the wide range of organisms, it is difficult to treat presumptively. Once gonococcal and chlamydial infections have been ruled out, one can follow the recommendations proposed for conjunctivitis in older children.

Neonatal conjunctivitis caused by Pseudomonas and other gramnegative bacteria should be treated with systemic antibiotics. Choices for presumptive treatment should be based on the susceptibility patterns for these organisms in your institution and should include an aminoglycoside (gentamicin, tobramycin, or amikacin) and expanded spectrum penicillin (ticarcillin–sulbactam, piperacillin–tazobactam, imipenem, or meropenem). Final choice of antibiotics results should be based on susceptibility testing of the isolate.

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REFERENCES & FOOTNOTES:

  • Samir S. Shah, M. M. (2009). PEDIATRIC PRACTICE Infectious Disease. New York, Chicago, San Francisco, Lisbon, London, Madrid, Mexico City: MC GRAW HILLS.
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