Neonatal Conjunctivitis Medication
- Author: Emily A McCourt, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc more...
The goals of pharmacotherapy are to reduce ocular and systemic morbidity and potential mortality and to eliminate the infection.
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Systemic treatment is necessary. Erythromycin treats C trachomatis infection. Erythromycin inhibits ribonucleic acid (RNA) ̶ dependent protein synthesis, possibly by stimulating dissociation of peptidyl transfer RNA (tRNA) from ribosomes. This inhibits bacterial growth.
Topical antimicrobial therapy is not necessary (but may help) if systemic therapy is given.
This is a bacteriostatic derivative of polycyclic naphthalene carboxamide; it is an alternative for chlamydial infection.
Penicillin G is the choice for penicillin-susceptible N gonorrhoeae infection. It interferes with the synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.
Bacitracin ophthalmic ointment for gram-positive cocci prevents the transfer of mucopeptides into the growing cell wall, inhibiting bacterial growth.
Ceftriaxone is a treatment for penicillinase-producing N gonorrhoeae. It is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Ceftriaxone arrests bacterial growth by binding to 1 or more penicillin-binding proteins.
An alternative treatment for N gonorrhoeae, cefotaxime arrests bacterial cell wall synthesis, which in turn inhibits bacterial growth.
Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum. It has lower efficacy against gram-positive organisms.
Systemic gentamicin is another alternative for penicillinase-producing N gonorrhoeae. Topical gentamicin also is used for other gram-negative bacterial infections.
Tobramycin ophthalmic for gram-negative bacilli interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in a defective bacterial cell membrane. It is available as a solution, ointment, or lotion.
Silver nitrate has been used to prevent gonorrheal ophthalmia neonatorum.
Povidone-iodine is an antibacterial agent with broad antibacterial and antiviral activity. No bacteria are known to be resistant. Povidone-iodine is far less expensive and less toxic than agents currently used to prevent neonatal conjunctivitis.
Viral keratitis therapy begins with mechanical debridement of the involved corneal epithelium along with a rim of normal epithelium. This is followed by the topical instillation of antiviral medications such as trifluridine or acyclovir.
Acyclovir inhibits the activity of HSV-1 and HSV-2. Patients experience less pain and faster resolution of cutaneous lesions when this agent is used within 48 hours after rash onset. It may prevent recurrent outbreaks.
A purine nucleoside, this is the drug of choice for herpes simplex keratitis. It is superior to either vidarabine or idoxuridine, having better penetration and greater effectiveness. It inhibits viral replication by incorporating into the viral DNA in place of thymidine. The topical preparation contains thimerosal preservative, known to be toxic to ocular epithelium. If trifluridine brings about no response in 7-14 days, consider other treatments.
Ganciclovir is available in a 0.15% gel. It inhibits the activity of HSV-1 and HSV-2 and demonstrates similar herpetic clinical cure rates to topical acyclovir in adults. Ganciclovir targets viral infected cells only, thereby reducing surface toxicity.
Credé. Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn. Am J Dis Child. 1971 Jan. 121(1):3-4. [Medline].
Rours IG, Hammerschlag MR, Ott A, De Faber TJ, Verbrugh HA, de Groot R, et al. Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants. Pediatrics. 2008 Feb. 121(2):e321-6. [Medline].
American Academy of Pediatrics. Chlamydia Trachomatis. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2009. 255-9.
American Academy of Pediatrics. Prevention of Neonatal Ophthalmia. Pickering LK, Baker CJ, Kimberlin DW, Long SS eds. Red Book 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2009. 827-9.
Chhabra MS, Motley WW 3rd, Mortensen JE. Eikenella corrodens as a causative agent for neonatal conjunctivitis. J AAPOS. 2008 Oct. 12(5):524-5. [Medline].
Chen CJ, Starr CE. Epidemiology of gram-negative conjunctivitis in neonatal intensive care unit patients. Am J Ophthalmol. 2008 Jun. 145(6):966-970. [Medline].
American Academy of Pediatrics. Herpes Simplex. Pickering LK, Baker CJ, Kimberlin DW, Long SS eds. Red Book 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2009. 363-73.
American Academy of Pediatrics. Gonococcal Infections. Pickering LK, Baker CJ, Kimberlin DW, Long SS eds. Red Book 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2009. 305-13.
Gul SS, Jamal M, Khan N. Ophthalmia neonatorum. J Coll Physicians Surg Pak. 2010 Sep. 20(9):595-8. [Medline].
Zuppa AA, D'Andrea V, Catenazzi P, Scorrano A, Romagnoli C. Ophthalmia neonatorum: what kind of prophylaxis?. J Matern Fetal Neonatal Med. 2011 Jun. 24(6):769-73. [Medline].
Pediatric Conjunctivitis. Wright, Kenneth and Strube, Yi Ning. Pediatric Ophthalmology and Strabismus. Third. New York, NY: Oxford University Press; 2012. 633-636.
Yip PP, Chan WH, Yip KT, Que TL, Kwong NS, Ho CK. The use of polymerase chain reaction assay versus conventional methods in detecting neonatal chlamydial conjunctivitis. J Pediatr Ophthalmol Strabismus. 2008 Jul-Aug. 45(4):234-9. [Medline].
Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E, et al. Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers. Ophthalmic Epidemiol. 2009 Nov-Dec. 16(6):337-45. [Medline].
Prevention of Neonatal Ophthalmia. Pickering LK, ed. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th Edition. Elk Grove Village, IL:
McDonald M, Hardten D, Mah F, O’Brien T, Rapuano C, Schanzlin D, et al. Management of Epithelial Herpetic Keratitis: An Evidence-Based Algorithm. Optometric Management. Available at http://www.optometricmanagement.com/content/bl/2/b-l_treament-finalnb.pdf. Nov 11, 2012;