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Ophthalmia%20neonatorum Treatment
Principles of Therapy
- Treatment is basically based on the clinical picture & laboratory diagnosis
- Infants should be hospitalized to monitor response to treatment especially those w/ septic neonatal conjunctivitis
- Systemic treatment is usually given rather than topical drugs in order that systemic dissemination may be prevented
Pharmacotherapy
Acyclovir
- Treatment option for viral neonatal conjunctivitis
- Recommended dosage: 30 mg/kg/day intravenous (IV) divided to 3 doses for at least 2 weeks
- By competing w/ deoxyguanosine triphosphate for viral DNA polymerase & by incorporation into viral DNA, it inhibits viral replication
- Eg Tobramycin, Gentamicin
- Gentamicin is an alternative treatment for gonococcal neonatal conjunctivitis
- Recommended dosage: intramuscular dose twice daily for 1 week
- Tobramycin & Gentamicin may be used as treatment for gram-negative bacteria causing neonatal conjunctivitis (except N. gonorrhea)
- Recommended dosage: Ointment or drops 4 times a day
- Alternative treatment for patients w/ chlamydial conjunctivitis intolerant to Erythromycin
- Recommended dosage: 20 mg/kg/day orally for 3 days
- Studies proving the efficacy of Azithromycin for chlamydial conjunctivitis are limited
- Treatment option for neonates w/ gonococcal conjunctivitis & hyperbilirubinemia
- Recommended dosage: 100 mg/kg IV or intramuscular (IM)
- Drug of choice for gonococcal neonatal conjunctivitis
- Recommended dosage: 25-50 mg/kg IV or IM as a single dose, not to exceed 125 mg
- Topical antibiotic therapy alone is inadequate & is unnecessary when systemic treatment is administered
- Inhibits bacterial growth by binding to one or more of the penicillin-binding proteins
- Use w/ caution in infants who is born prematurely & w/ hyperbilirubinemia
- Drug of choice for chlamydial neonatal conjunctivitis
- Recommended dosage: 50 mg/kg/day orally in 4 divided doses for 14 days
- Topical antibiotic therapy alone is inadequate & is unnecessary when systemic treatment is administered
- Advantages of oral Erythromycin include: Eradication of the nasopharyngeal carriers, treatment of associated pneumonitis & also being more effective than topical in preventing relapse of conjunctivitis
- A second course of treatment may be required thus monitoring the response to treatment is necessary
- Also used for treatment of other gram-positive bacteria causing neonatal conjunctivitis
- Dosage: 0.5% ointment 4 times a day
- May cause infantile hypertrophic pyloric stenosis
- Signs & symptoms of this disease (eg intestinal obstruction) should be monitored
- Alternative treatment for gonococcal neonatal conjunctivitis
- Recommended dosage: 100,000 units/kg/day IV in 4 divided doses for 1 week
- Inhibits bacterial growth by binding to one or more of the penicillin-binding proteins
- Treatment option for viral neonatal conjunctivitis
- Recommended dosage: 1% ophthalmic drops every 2 hours for 7 days
- Inhibits viral replication by incorporating into the viral DNA in place of thymidine
- Adjunct therapy to Acyclovir for the treatment of viral neonatal conjunctivitis
- Easy to administer, safe & inexpensive in preventing sight-threatening gonococcal neonatal conjunctivitis
- Drug of choice for neonatal conjunctivitis prophylaxis
- Recommended dosage: 0.5% Erythromycin ointment 1 cm ribbon in each eye as single dose applied as soon as possible after birth
- Preferred prophylaxis than silver nitrate due to less incidence of chemical conjunctivitis
- Effective prophylaxis for gonococcal neonatal conjunctivitis but not in chlamydial neonatal conjunctivitis
- Inhibits bacterial growth by inhibiting bacterial RNA-dependent protein synthesis
- Alternative prophylaxis for chlamydial neonatal conjunctivitis
- 2.5% ophthalmic soln in each eye applied as soon as possible after birth
- Studies have shown that it has superior bactericidal effects & also active against viruses but further studies are recommended
- More effective as a prophylaxis for N. gonorrhea than Erythromycin & should be used in areas where that organism is prevalent
- Not effective prophylaxis for C. trachomatis
- Usage as prophylaxis is discouraged as it can cause chemical neonatal conjunctivitis
- Alternative prophylaxis for chlamydial neonatal conjunctivitis
- Recommended dosage: 1% Tetracycline ointment 1 cm ribbon in each eye as single dose applied as soon as possible after birth
- Inhibits bacterial protein synthesis by binding to the 30S & possible the 50S ribosomal subunits of susceptible bacteria preventing additions of amino acids to the growing peptide chain
Non-Pharmacological Therapy
Observation
- Chemical conjunctivitis usually resolves w/in 24-36 hours unless there is bacterial infection complication
- In gonococcal conjunctivitis, normal saline irrigation helps remove the mucopurulent debris from the lids & conjunctiva
- May be performed 4 times a day
