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).
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