Conjunctivitis Neonatal (Ophthalmia Neonatorum) - Guideline for the Management of
|Last review: 27/06/2019|
|Next review: 27/06/2022|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2019|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Guideline for the Management of Neonatal Conjunctivitis (Ophthalmia Neonatorum)
Conjunctivitis Neonatal (Ophthalmia Neonatorum)
The more pronounced these signs are the more severe the conjunctivitis. Classify conjunctivitis as:
Suspect gonococcal or chlamydial infection when conjunctivitis appears with:
However, the history may not reveal any clues and if gonococcal or chlamydial infection is suspected it must be treated as such.
The laboratory should be called to alert them that an urgent sample is on its way. (During normal working hours Ext. No0113-392-3499, out of hours bleep 2543 or contact duty laboratory Microbiologist via switchboard.) Gen Probe Aptima swabs are available from microbiology.
Empirical (initial) antimicrobial management.
onsider referral to ophthalmology after treatment has been initiated: severe cases and gonococcal/chlamydial conjunctivitis.
|Empirical Antimicrobial Treatment|
Topical antibiotics should be started only after swabs have been taken.
Mild: no topical antimicrobials
NB drops are preferable to ointment as irrigation of the eye is part of treatment.
If a baby is unwell with systemic symptoms in addition to conjunctivitis assess and manage the baby according to neonatal sepsis guidelines (detail.aspx?id=201) targeting antibiotic therapy where gonococcal or chlamydial conjunctivitis is suspected
|Directed Antimicrobial Treatment (when microbiology results are known)|
Change antibiotics when gram stain results and/or culture results are known.
If Gram negative diplococci are seen on Gram stain, treat as for gonococcal disease.
Ceftriaxone is contraindicated in neonates less than 41 weeks postmenstrual age; neonates over 41 weeks postmenstrual age with jaundice, hypoalbuminemia, or acidosis; concomitant treatment with intravenous calcium (including total parenteral nutrition containing calcium) in neonates over 41 weeks postmenstrual age—risk of precipitation in urine and lungs
Chlamydial infection (including) conjunctivitis
Maternal infection which has been treated with a full course of erythromycin either during and/or before this pregnancy.Monitoring for signs of pyloric stenosis is needed as cases are reported with macrolides given under the age of 6 weeks.
|Duration of Treatment|
Topical antibiotics should be continued for 5 days or 48 hours after the symptoms have settled, whichever is sooner
|Switch to oral agent(s)|
Not applicable for cases not treated with systemic antimicrobials.
Chlamydia switch to oral erythromycin when systemically well and clinically improving.
Suspected gonococcal conjunctivitis
|Target patient group:||Babies in the neonatal period|
|Target professional group(s):||Pharmacists
Secondary Care Doctors
- KARL E. MILLER, Diagnosis and Treatment of Chlamydia trachomatis Infection. American Family Physician. 2006;73(8):1411-1416
- Robertson’s Textbook of Neonatology, 3rd Ed.
- Centres for disease control and prevention MMWR Recomm Rep. 2006 August 55 (RR11) 1-94
- Sexually Transmitted Diseases Treatment Guidelines 2006 Centres for disease control and prevention
- 2008 European (IUSTI/WHO) Guideline on the Diagnosis and Treatment of Gonorrhoea.
- Andrew Zikic Treatment of Neonatal Chlamydial conjunctivitis Paediatric Infectious Dis Soc.2018 aug.
Improving Antimicrobial Prescribing Group
LHP version 2.0
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