Ophthalmia neonatorum
Conjunctivitis of the neonate - Ophthalmia neonatorum
Conjunctivitis in neonates may be due to a number of causes and time of onset from birth varies with the likely pathogen.
- Non-infectious: First 24 hours. Usually self-limiting, no treatment required.
- Neisseria gonorrhoea: Birth to 5 days. Requires treatment.
- Chlamydia trachomatis: 5 to 14 days. Requires treatment.
- Other bacteria: 4 to 5 days but can be any time. Often self-limiting.
- HSV: 7 to 14 days. Requires treatment. If HSV suspected, follow congenital HSV guidelines (available here).
Take appropriate blood cultures and samples (e.g. blood culture and PCR for chlamydia and gonorrhoea).
Empiric treatment (and HSV is not suspected)
Chloramphenicol 0.5% eye drops 4 hourly (frequency may be increased depending on severity)
AND
Erythromycin 12.5mg/kg po or iv QDS
AND
Cefotaxime 100mg/kg iv STAT. If systemic disease, continue with Cefotaxime iv, see dosing table below.
Treatment should continue for 7 days. If meningitis is suspected or proven the duration should be 14 days.
Cefotaxime dosing:
| Age | Cefotaxime iv dosing |
| up to 7 days | 50 mg/kg iv BD |
| 7 days to 28 days | 50 mg/kg iv TDS |
Chlamydia trachomatis
Erythromycin 12.5mg/kg po or iv QDS for 14 days
Neisseria gonorrhoea
For treatment of eye infection without systemic disease: Cefotaxime 100mg/kg iv STAT
If systemic disease present continue with Cefotaxime iv, see dosing table below.
Treatment should continue for 7 days. If meningitis is suspected or proven the duration should be 14 days.
Cefotaxime dosing:
| Age | Cefotaxime iv dosing |
| up to 7 days | 50 mg/kg iv BD |
| 7 days to 28 days | 50 mg/kg iv TDS |
Herpes simplex virus
Aciclovir 20mg/kg iv TDS for 14 days (21 days if there is CNS involvement)
See HSV treatment guidelines (available here).
Additional Comments
After safety concerns regarding boron exposure in children under 2 years of age, an MHRA Review (2021) concluded that chloramphenicol eye drops containing borax or boric acid can be safely administered where treatment is indicated