What is the treatment for chlamydial (Chlamydia trachomatis) conjunctivitis?

From the Guidelines

Chlamydial eye infections should be treated with azithromycin suspension 20 mg/kg body weight/day orally once a day for 3 days, as this is the most effective and convenient treatment option, especially in pediatric patients. When considering treatment for chlamydia in the eye, it's crucial to prioritize the most recent and highest quality evidence, which in this case is from the 2024 study on conjunctivitis preferred practice pattern published in Ophthalmology 1. The treatment options outlined in this study include cefotaxime, erythromycin base or ethylsuccinate, and azithromycin suspension, with the latter being the most suitable for ocular chlamydia due to its efficacy and ease of administration. Some key points to consider when treating chlamydial eye infections include:

• The importance of completing the full course of antibiotics, even if symptoms improve before finishing treatment
• The need to treat sexual partners simultaneously to prevent reinfection
• The potential for ocular chlamydia to lead to scarring of the cornea and potentially vision loss if left untreated
• The recommendation to avoid touching or rubbing the infected eye, wash hands frequently, and not share towels or pillowcases during treatment It's also worth noting that pregnant women should not be treated with doxycycline, quinolones, or tetracyclines, and instead should be treated with either erythromycin or amoxicillin, as stated in the Centers for Disease Control and Prevention's Sexually Transmitted Diseases Treatment Guidelines, 2021 1.

From the FDA Drug Label

For prophylaxis of ophthalmia neonatorum due to N. gonorrhoeae or C. trachomatis. In the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin. The treatment for chlamydia in the eye is erythromycin ophthalmic ointment.

• Apply approximately 1 cm in length directly to the infected eye(s)
• Up to six times daily, depending on the severity of the infection 2 2.

From the Research

Treatment for Chlamydia in the Eye

The treatment for chlamydia in the eye typically involves the use of antibiotics. Some key points to consider include:

• The recommended treatment is oral tetracycline or erythromycin, as stated in the study 3.
• Systemic antibiotics are necessary, and not just topical application of antibiotics to the eye, as mentioned in the study 4.
• Effective anti-chlamydial agents include tetracyclines, macrolides, and some of the fluoroquinolones, according to the study 4.
• Prolonged and frequent application of ophthalmic agents is vital for successful treatment of conjunctivitis, as noted in the study 4.

Antibiotic Options

Some studies have compared the effectiveness of different antibiotic regimens, including:

• Azithromycin versus doxycycline, with azithromycin being less effective for microbiological failure in men, but possibly having fewer adverse events, as reported in the study 5.
• Doxycycline versus ofloxacin, with uncertain effects on microbiological failure and clinical failure, according to the study 5.
• Other antibiotics, such as erythromycin and tetracycline, have also been used to treat chlamydia, as mentioned in the study 6.

Important Considerations

It's essential to note that:

• The treatment of chlamydial eye infection in adults means controlling the concomitant genital infection as well, as stated in the study 3.
• The Global Elimination of Trachoma 2020 program by the WHO uses the SAFE strategy (surgery for trachomatous trichiasis; Antibiotics for C. trachomatis; Facial cleanliness; and environmental improvement) to reduce the prevalence of trachoma, as reported in the study 7.