What is the treatment for neonatal conjunctivitis (newborn with green sticky eyes)?

Treatment of Neonatal Conjunctivitis (Green Sticky Eyes)

For neonatal conjunctivitis with green sticky discharge, systemic erythromycin (50 mg/kg/day orally divided into 4 doses daily for 14 days) is the recommended treatment, as topical antibiotics alone are inadequate for treating chlamydial infection, which is the most common cause.

Diagnostic Approach

When evaluating a newborn with green sticky eye discharge, consider the following:

• Timing of onset:

  • 1-7 days after birth: Suggests gonococcal infection
  • 5-12 days after birth: Highly suggestive of chlamydial infection
  • First week: Common bacterial infection (Staphylococcus aureus, Enterococcus, Klebsiella, E. coli) 1

• Diagnostic testing:

  • Obtain conjunctival swabs for culture and specific testing
  • Specimens must contain conjunctival cells, not just exudate
  • Swab the everted eyelid using a dacron-tipped swab 2
  • Test for both Chlamydia trachomatis and Neisseria gonorrhoeae

Treatment Algorithm

1. Chlamydial Conjunctivitis (Most common cause)

• Treatment: Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 days 2
• Topical antibiotics alone are inadequate for chlamydial infection 2
• Follow-up is essential as treatment efficacy is approximately 80%; a second course may be required 2
• Consider potential concomitant chlamydial pneumonia 2

2. Gonococcal Conjunctivitis

• Treatment: Ceftriaxone 25-50 mg/kg IV or IM in a single dose (not to exceed 125 mg) 2
• Hospitalization and evaluation for signs of disseminated infection
• Topical therapy alone is inadequate 2

3. Common Bacterial Conjunctivitis

• For mild to moderate cases without chlamydial or gonococcal etiology:
  • Topical antibiotics such as erythromycin ophthalmic ointment 3
  • Apply approximately 1 cm in length directly to the infected eye(s) up to six times daily 3

Important Considerations

1. Maternal and partner treatment:

   • The mothers of infants with chlamydial or gonococcal infection and their sex partners must be evaluated and treated 2
   • This prevents reinfection and further transmission

2. Follow-up:

   • Essential to ensure resolution of infection
   • Particularly important for chlamydial infections where treatment efficacy is ~80% 2

3. Prevention:

   • Neonatal ocular prophylaxis with erythromycin ointment at birth helps prevent gonococcal ophthalmia but does not prevent chlamydial infection 2
   • Prenatal screening and treatment of pregnant women is the most effective prevention strategy 2

Common Pitfalls to Avoid

1. Using only topical antibiotics for chlamydial conjunctivitis - systemic treatment is essential 2

2. Failure to test for both chlamydia and gonorrhea - both pathogens require different treatment approaches 2

3. Not treating the mother and her partners - this is crucial to prevent reinfection 2

4. Inadequate follow-up - particularly important given the ~80% efficacy rate of erythromycin for chlamydial infections 2

5. Missing concomitant infections - chlamydial pneumonia may develop in infants with chlamydial conjunctivitis 2