Treatment
Prophylaxis needs antenatal, natal, and post-natal care.
- Antenatal measures include thorough care of mother and treatment of genital infections when suspected.
- Natal measures are of utmost importance as mostly infection occurs during childbirth. Deliveries should be conducted under hygienic conditions taking all asceptic measures. The newborn baby's closed lids should be thoroughly cleansed and dried.
- Postnatal measures include:
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- Use of 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution (Crede's method) into the eyes of babies immediately after birth
- Single injection of ceftriaxone 50 mg/kg IM or IV should be given to infants born to mothers with untreated gonococcal infection.
- Curative treatment as a rule, conjunctival cytology samples and culture sensitivity swabs should be taken before starting treatment
- Chemical ophthalmia neonatorum is a self-limiting condition and does not require any treatment.
- Gonococcal ophthalmia neonatorum needs prompt treatment to prevent complications. Topical therapy should include
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- Saline lavage hourly till the discharge is eliminated
- Bacitracin eye ointment four times per day (Because of resistant strains topical penicillin therapy is not reliable. However in cases with proved penicillin susceptibility, penicillin drops 5000 to 10000 units per ml should be instilled every minute for half an hour, every five minutes for next half an hour and then half-hourly till infection is controlled)
- If the cornea is involved then atropine sulphate ointment should be applied.
- The advice of both the pediatrician and ophthalmologist should be sought for proper management.
Systemic therapy: Neonates with gonococcal ophthalmia neonatorum should be treated for seven days with one of the following regimens
| Ceftriaxone 75–100 mg/kg/day IV or IM, QID |
| Cefotaxime 100–150 mg/kg/day IV or IM, 12 hourly |
| Ciprofloxacin 10–20 mg/kg/day or Norfloxacin 10 mg/kg/day |
| Crystalline benzyl penicillin G 50,000 units (for full-term normal weight babies) or 20,000 units (for premature or low weight babies) IM twice daily for three days (if the organism is penicillin susceptible) |
- Other bacterial ophthalmia neonatorum should be treated by broad spectrum antibiotics drops and ointment for two weeks.
- Neonatal inclusion conjunctivitis caused by Chlamydia trachomatis responds well to topical tetracycline 1% or erythromycin 0.5% eye ointment QID for three weeks. However systemic erythromycin should also be given since the presence of chlamydia agents in conjunctiva implies colonization of upper respiratory tract as well. Both parents should also be treated with systemic erythromycin.
- Herpes simplex conjunctivitis is usually a self-limiting disease. Topical antiviral drugs control the infection more effectively and may prevent recurrence.
Read more about this topic: Neonatal Conjunctivitis
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