Medication Summary
The goals of pharmacotherapy are to reduce ocular and systemic morbidity and potential mortality and to eliminate the infection.
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.
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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Severe purulent discharge and eyelid edema in a newborn with gonococcal conjunctivitis (confirmed with Gram stain and culture).
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Cloudy cornea without ulcer in neonatal gonococcal conjunctivitis.
