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Neonatal Conjunctivitis Medication

  • Author: Emily A McCourt, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
 
Updated: Jan 11, 2016
 

Medication Summary

The goals of pharmacotherapy are to reduce ocular and systemic morbidity and potential mortality and to eliminate the infection.

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Antimicrobial agents

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Erythromycin (E.E.S.400, Ery Tab, PCE, Erythrocin)

 

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.

Tetracycline

 

This is a bacteriostatic derivative of polycyclic naphthalene carboxamide; it is an alternative for chlamydial infection.

Penicillin G (Pfizerpen-G)

 

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

 

Bacitracin ophthalmic ointment for gram-positive cocci prevents the transfer of mucopeptides into the growing cell wall, inhibiting bacterial growth.

Ceftriaxone (Rocephin)

 

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.

Cefotaxime (Claforan)

 

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.

Gentamicin (Garamycin, Gentak)

 

Systemic gentamicin is another alternative for penicillinase-producing N gonorrhoeae. Topical gentamicin also is used for other gram-negative bacterial infections.

Tobramycin ophthalmic (Tobrex)

 

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

 

Silver nitrate has been used to prevent gonorrheal ophthalmia neonatorum.

Povidone-iodine ophthalmic solution 5% (Betadine)

 

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.

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Antiviral agents

Class Summary

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 (Zovirax)

 

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.

Trifluridine ophthalmic solution (Viroptic)

 

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 ophthalmic (Zirgan)

 

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.

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Contributor Information and Disclosures
Author

Emily A McCourt, MD Assistant Professor of Pediatric Ophthalmology and Adult Strabismus, Children's Hospital Colorado, University of Colorado Denver School of Medicine

Emily A McCourt, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Feng Zhao, MD, PhD Private Practice, Allatoona Eye Institute

Feng Zhao, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Georgia Society of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Robert William Enzenauer, MD, MPH, MBA, MSS Professor, Department of Ophthalmology, University of Colorado School of Medicine; Chairman, Department of Ophthalmology, Children's Hospital

Robert William Enzenauer, MD, MPH, MBA, MSS is a member of the following medical societies: American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American Association for Physician Leadership, American Academy of Ophthalmology

Disclosure: CLEAR DONOR: Received consulting fee from Clear Donor for consulting; Partner received salary from Clear Donor for employment.

Kalpana K Jatla, MD Private Practice, Clarity Eye Center

Kalpana K Jatla, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Acknowledgements

Gerhard W Cibis, MD Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

References
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