What is the treatment for a newborn with Escherichia coli (E. coli) infection in the eye?

Treatment of E. coli Eye Infection in Newborns

For newborns with Escherichia coli (E. coli) eye infection, treatment should include topical fluoroquinolone eye drops such as moxifloxacin, along with systemic antibiotics if there are signs of systemic infection. 1

Initial Assessment and Diagnosis

• Evaluate for signs of sepsis including:

  • Tachycardia
  • Tachypnea
  • Lethargy
  • Temperature instability
  • Poor feeding
  • Irritability

• If sepsis is suspected, perform a full diagnostic evaluation:

  • Blood culture
  • Complete blood count with differential and platelet count
  • Chest radiograph (if respiratory symptoms present)
  • Lumbar puncture (if stable enough to tolerate the procedure)
  • Consider urine culture (E. coli commonly causes UTIs) 2, 3

Treatment Protocol

For Isolated E. coli Eye Infection (No Systemic Symptoms):

1. Topical Therapy:

   • First-line: Fluoroquinolone ophthalmic drops (e.g., moxifloxacin) 1
   • Apply every 2-4 hours initially, then taper based on clinical response
   • Continue for 7-10 days or until complete resolution

2. Monitoring:

   • Daily assessment of eye discharge, redness, and swelling
   • Watch for signs of systemic infection

For E. coli Eye Infection with Suspected Systemic Involvement:

1. Systemic Antibiotics:

   • For infants ≤7 days old: Ampicillin plus an aminoglycoside (e.g., gentamicin) 2, 3
   • For infants 8-28 days old: Ampicillin plus ceftazidime 2
   • For infants 29-90 days old: Ceftriaxone 2

2. Duration of Therapy:

   • For isolated conjunctivitis: 7-10 days
   • For bacteremia: 10-14 days
   • For meningitis: 14-21 days 3

Important Considerations

• E. coli is an unusual cause of ophthalmia neonatorum but requires prompt treatment to prevent complications 1
• E. coli eye infections can progress rapidly, with irreversible damage occurring in less than 24 hours 4
• Unlike gonococcal ophthalmia neonatorum (which requires erythromycin 0.5% ophthalmic ointment for prophylaxis), E. coli infections may respond better to fluoroquinolones 2, 1
• Gram-negative bacteria like E. coli may have unpredictable antimicrobial susceptibilities and can be highly resistant to standard antibiotics 2

Follow-up Care

• Regular ophthalmologic examinations until complete resolution
• If systemic infection was present, follow-up blood cultures to confirm clearance
• Monitor for complications such as corneal scarring or perforation

Pitfalls to Avoid

• Delaying treatment while awaiting culture results - start empiric therapy immediately
• Failing to evaluate for systemic infection - E. coli eye infections can be a sign of sepsis
• Inadequate follow-up - ensure complete resolution before discontinuing treatment
• Underestimating the severity - E. coli endophthalmitis has historically poor outcomes if not treated aggressively 4, 5, 6, 7

Remember that E. coli eye infections in newborns are relatively uncommon but can be serious. Early recognition and appropriate treatment are essential to prevent vision-threatening complications and potential systemic spread.