What is the recommended treatment for bacterial conjunctivitis in a pregnant woman?

From the Guidelines

For bacterial conjunctivitis in pregnant women, erythromycin ophthalmic ointment (0.5%) applied to the affected eye(s) 2-4 times daily for 5-7 days is the recommended first-line treatment, as it is considered safe and effective, according to the most recent guidelines 1.

Key Considerations

• Bacterial conjunctivitis typically presents with purulent discharge, redness, and crusting of the eyelids, especially upon waking.
• While many cases of conjunctivitis will resolve spontaneously within 7-14 days, antibiotic treatment can speed recovery, reduce symptom duration, and prevent transmission to others.
• Pregnant women should also practice good hygiene by washing hands frequently, avoiding touching or rubbing the eyes, using separate towels and washcloths, and disposing of eye makeup that may be contaminated.

Treatment Options

• Erythromycin ophthalmic ointment (0.5%) is the preferred treatment, but azithromycin ophthalmic solution (1%) can be used as an alternative, once or twice daily for 3 days.
• These antibiotics are considered pregnancy category B medications, meaning they have shown no evidence of risk in animal studies and are generally considered safe during pregnancy 1.

Important Notes

• If symptoms worsen or do not improve after 48-72 hours of treatment, the patient should seek further medical evaluation.
• It is essential to follow the recommended treatment guidelines to ensure the best possible outcome for both the mother and the fetus.
• The Centers for Disease Control and Prevention (CDC) recommends that patients treated for gonococcal infection also be treated routinely with a regimen effective against uncomplicated genital Chlamydia trachomatis infection, as patients infected with Neisseria gonorrhoeae often are coinfected with C. trachomatis 1.

From the FDA Drug Label

The recommended dosage regimen for the treatment of bacterial conjunctivitis is: Instill 1 drop in the affected eye(s) twice daily, eight to twelve hours apart for the first two days and then instill 1 drop in the affected eye(s) once daily for the next five days. AzaSite ® is indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following microorganisms: CDC coryneform group G, Haemophilus influenzae, Staphylococcus aureus, Streptococcus mitis group, Streptococcus pneumoniae

The recommended treatment for bacterial conjunctivitis in a pregnant woman is azithromycin ophthalmic solution (AzaSite), with a dosage regimen of:

• 1 drop in the affected eye(s) twice daily for the first two days
• 1 drop in the affected eye(s) once daily for the next five days 2 Key considerations:
• Ensure the patient is not hypersensitive to any component of the product
• Avoid contaminating the applicator tip and advise the patient not to wear contact lenses if they have signs or symptoms of bacterial conjunctivitis

From the Research

Bacterial Conjunctivitis Treatment in Pregnant Women

• The treatment for bacterial conjunctivitis in pregnant women is not explicitly mentioned in the provided studies, but we can look at the treatment of other bacterial infections during pregnancy for guidance 3.
• For bacterial infections such as gonorrhea and chlamydia, the recommended treatment is intramuscular ceftriaxone or oral cefixime, and oral azithromycin for chlamydial infection 3.
• However, these studies do not specifically address the treatment of bacterial conjunctivitis in pregnant women.
• It is essential to note that the treatment of bacterial conjunctivitis in pregnant women should be guided by the severity of the infection and the potential risks to the fetus.

Prevention of Neonatal Conjunctivitis

• Prenatal screening and treatment of pregnant women for Neisseria gonorrhoeae and Chlamydia trachomatis is the most effective way to prevent ophthalmia neonatorum 4.
• Erythromycin ointment has been shown to be effective in preventing chlamydial conjunctivitis in newborns 5.
• Prophylaxis with silver nitrate solution, 1.0% tetracycline, or 0.05% erythromycin ointment is effective for the prevention of gonococcal and chlamydial conjunctivitis in the newborn 6.

Use of Ophthalmic Corticosteroids in Pregnant Women

• The use of topical ophthalmic corticosteroids in pregnant women with allergic conjunctivitis was not associated with an increase in adverse neonatal outcomes such as congenital anomalies, preterm birth, or low birthweight 7.
• However, this study does not address the use of ophthalmic corticosteroids in the treatment of bacterial conjunctivitis in pregnant women.