Review Question - QID 105381

This patient's presentation of bilateral eye discharge on day 3 of life is consistent with gonococcal ophthalmia neonatorum. Topical 0.5% erythromycin applied immediately after birth is effective prevention against the development of neonatal gonococcal conjunctivitis (gonococcal ophthalmia neonatorum).

Chemical, gonococcal, and chlamydial conjunctivitis are common causes of conjunctivitis in the newborn. They may be easily differentiated based on the time of presentation. Chemical conjunctivitis often occurs within the first 24 hours of life and is typically secondary to the use of certain prophylactic topical ointments applied to newborns to prevent gonococcal conjunctivitis (such as silver-based formulas). Gonococcal conjunctivitis occurs 3-5 days after birth with a more profuse purulent discharge, and chlamydial conjunctivitis occurs 5-10 days after birth. The treatment of active gonococcal conjunctivitis is both ceftriaxone and topical erythromycin. Topical erythromycin can protect against gonococcal conjunctivitis if given at birth.

Figure A displays an infant suffering from neonatal gonococcal conjunctivitis with bilateral purulent eye discharge.

Incorrect Answers:
Answer 1: Acyclovir is used to treat neonatal herpetic conjunctivitis, which may present with vesicles on the skin surrounding the eyes or other evidence of systemic involvement.

Answer 2: Azithromycin is not used in the treatment/prevention of conjunctivitis in the newborn.

Answer 3: Ceftriaxone is a recommended agent for the treatment of neonatal gonococcal conjunctivitis; however, it is not given as a prophylactic measure to prevent infection.

Answer 5: Topical silver sulfadiazine could be used as prophylaxis against infection; however, it can cause a chemical conjunctivitis. Topical erythromycin is the preferred agent.

Bullet Summary:
Topical erythromycin should be given to newborns as prophylaxis against eonatal gonococcal conjunctivitis.