Treatment of Chlamydia and Gonorrhea in the Eyes
For ocular infections caused by chlamydia or gonorrhea, systemic antibiotics are required, with specific regimens based on the causative organism, patient age, and pregnancy status. 1
Adult Treatment Regimens
Gonococcal Conjunctivitis
- Ceftriaxone 1g IM single dose is the recommended treatment for gonococcal conjunctivitis in adults 1
- The infected eye should be lavaged with saline solution once to promote comfort and faster resolution 1
- For cephalosporin-allergic patients, consider azithromycin 2g orally as a single dose, though this is not preferred due to concerns about antimicrobial resistance 1
Chlamydial Conjunctivitis
- Azithromycin 1g orally as a single dose OR
- Doxycycline 100mg orally twice daily for 7 days OR
- Levofloxacin 500mg orally once daily for 7 days 1
Pediatric Treatment Regimens
Gonococcal Conjunctivitis
- For children weighing ≤45kg: Ceftriaxone 25-50mg/kg IV or IM single dose (not to exceed 250mg) 1
- For children weighing >45kg: Use adult treatment regimens 1
Chlamydial Conjunctivitis
- For children <8 years weighing <45kg: Erythromycin base or ethylsuccinate 50mg/kg/day orally divided into four doses daily for 14 days 1
- For children ≥8 years: Azithromycin 1g orally single dose OR Doxycycline 100mg orally twice daily for 7 days 1, 2
Neonatal Treatment
Gonococcal Ophthalmia Neonatorum
- Ceftriaxone 25-50mg/kg IV or IM single dose (not to exceed 250mg) 1
- For prophylaxis at birth: Erythromycin 0.5% ophthalmic ointment in each eye in a single application 1, 3
Chlamydial Ophthalmia
- Erythromycin base or ethylsuccinate 50mg/kg/day orally divided into four doses daily for 14 days OR
- Azithromycin suspension 20mg/kg/day orally once daily for 3 days 1
Special Considerations
Pregnancy
- Pregnant women should NOT be treated with doxycycline, quinolones, or tetracyclines 1
- For chlamydial conjunctivitis in pregnancy: Azithromycin 1g orally single dose OR Amoxicillin 500mg orally three times daily for 7 days 1
Coinfection Management
- Patients with gonococcal infection should be treated routinely for chlamydia, as coinfection is common 1, 2
- Sexual partners of infected patients should be evaluated and treated to prevent reinfection 2
Follow-up Recommendations
- Patients should be retested approximately 3 months after treatment to ensure eradication 1, 2
- For pregnant women with chlamydial infection, a test of cure 3 weeks after treatment is recommended 1
- Patients should abstain from sexual activity until they and their partners complete treatment and are symptom-free 1
Important Clinical Pearls
- Topical antibiotics alone are insufficient for chlamydial or gonococcal conjunctivitis; systemic therapy is required 4, 5
- Single-dose azithromycin has been shown to be as effective as a 10-day course of doxycycline for chlamydial conjunctivitis 6
- For severe infections, obtain conjunctival cultures before initiating treatment 4
- Recent CDC guidelines have increased the recommended ceftriaxone dose for gonococcal infections due to concerns about antimicrobial resistance 7