Treatment of neonatal chlamydia conjunctivitis

Neonatal ophthalmia, or neonatal conjunctivitis, is an acute mucopurulent conjunctivitis occurring within the first 28 days of life. This form of conjunctivitis is a relatively common pathological condition, which can be caused by chemicals, bacteria or viruses and affects between 1.6% and 12% of all neonates and up to 23% of newborns.born in developing countries.¹

The causes of neonatal ophthalmia can be classified into non-infectious and infectious.¹

La Chlamydia trachomatis is the most common cause of infectious neonatal conjunctivitis, accounting for between 2% and 40% of cases.¹

La Chlamydia is the most common sexually transmitted bacterial infection in the world. The estimated global incidence of the infection is approximately 131 million new cases per year. Although infection with Chlamydia trachomatis typically affects sexually active adults, can be transmitted to infants by the infected mother during birth. Approximately 30-50% of children born to a mother with active Chlamydia will develop neonatal conjunctivitis.²

Neonatal conjunctivitis caused by Chlamydia trachomatis is an acute infection of the conjunctiva characterised by erythema and oedema of the eyelids and palpebral conjunctiva and purulent ocular discharge. It usually occurs 5-14 days after birth.²

Although it is generally a mild disease, complications such as scarring of the cornea or conjunctiva may occur if not treated promptly. In addition, up to 20% of infants exposed to Chlamydia during delivery may develop pneumonia and in approximately 50% of them there is evidence of previous conjunctivitis.² Neonatal ophthalmia is also still one of the main causes of blindness, especially in developing countries.¹

Therapeutic approaches

For the treatment of infants with conjunctivitis by Chlamydia trachomatis, the World Health Organisation (WHO) guidelines for sexually transmitted diseases recommend using azithromycin in an oral formulation, 20mg/kg/day, one dose per day for 3 days.³

Azithromycin is preferred over erythromycin because of the potential risk of serious adverse events (such as pyloric stenosis) in infants treated with erythromycin.³

Prophylaxis for the prevention of neonatal conjunctivitis

Due to the potential complications associated with neonatal ophthalmia, many countries have implemented routine prophylaxis or preventive treatment for neonatal conjunctivitis.¹

Agents currently used in the prevention of neonatal ophthalmia include¹:

• -1% silver nitrate for topical use
• -targesin (a compound of silver and protein)
• -tetracycline at 1%
• -topical macrolide antibiotics, including erythromycin 0.5% or azithromycin
• topical -aminoglycosides, including gentamicin and tobramycin
• -chloramphenicol
• -fluoroquinolones, including ciprofloxacin
• -iodopovidone at 1.25% or 2.5%
• -Fusidic acid

Several high-income countries have abandoned newborn eye prophylaxis and replaced it with routine prenatal screening and treatment of mothers with a sexually transmitted infection, resulting in a decrease in the incidence of neonatal Chlamydia and Gonorrhoea infections.²

The WHO guidelines for sexually transmitted diseases recommend, however, topical eye prophylaxis for the prevention of neonatal gonococcal and Chlamydia conjunctivitis for all newborns.³

Bibliography:

1) Snježana Kaštelan et al, A Survey of Current Prophylactic Treatment for Ophthalmia Neonatorum in Croatia and a Review of International Preventive Practices, Med Sci Monit, . 2018 Nov 10;24:8042-8047. doi: 10.12659/MSM.910705.

2) Andrew Zikic et al, Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis, J Pediatric Infect Dis Soc, . 2018 Aug 17;7(3):e107-e115. doi: 10.1093/jpids/piy060.

3) WHO Guidelines for the Treatment of Chlamydia trachomatis 2016

Dr. Carmelo Chines
Direttore responsabile