Conjunctivitis chlamydial

For prophylaxis of ophthalmia neonatorum, various groups have proposed the use of erythromycin (0.5%) or tetracycline (1%) ophthalmic ointment in lieu of silver nitrate. Although silver nitrate and antibiotic ointments are effective against gonococcal ophthalmia neonatorum, silver nitrate is not effective for chlamydial disease and may cause a chemical conjunctivitis. 

Although erythromycin is a well-established antibiotic, there are relatively few primary indications for its use. These indications include the treatment of Mycoplasma pneumoniae infections, eradication of Corynebacterium diphtheriae from pharyngeal carriers, the early preparox-ysmal stage of pertussis, chlamydial infections, and more recently, the treatment of Legionnaires disease, Campylobacter enteritis, and chlamydial conjunctivitis, and the prevention of secondary pneumonia in neonates. 

Ophthalmic Treatment of blepharitis, conjunctivitis, keratitis, chlamydial trachoma... 

Erythromycin is also an effective alternative to tetracycline for the treatment of adult chlamydial sexually transmitted disease. Adults should receive 2 g of erythromycin daily in four divided doses for at least 7 days. Trachoma and inclusion conjunctivitis in older children or adults... 

A single 1-g dose of azithromycin is a recommended treatment for chlamydial urethritis and cervicitis. Similarly, a single 1-g dose is effective for the treatment of chlamydial conjunctivitis and trachoma in adolescents and adults, whereas a single oral dose of 20 mgAg can be used for treatment in children. 

Severe infection such as gonococcal conjunctivitis requires systemic therapy, which may be used in conjunction with topical agents. Treatment of viral infections often is directed at relieving patient symptoms, because specific antiviral agents do not currently exist in most cases. Chlamydial disease requires systemic therapy frequently combined with adjunctive topical therapy. 

Topical tetracycline may be nsed as an adjnnctive therapy for chlamydial infections but not for initial treatment of acute bacterial conjunctivitis. Numerous organisms are resistant to tetracycline. 

All patients with suspected or confirmed chlamydial conjunctivitis should be tested for other sexually transmitted diseases and evaluation and consideration given to comanagement with a gynecologist or urologist. If left untreated, chlamydial vaginitis can result in severe pelvic inflammatory disease, ectopic pregnancy, and infertility. Sexual partners of infected individuals should also receive systemic antibiotics, even if no symptoms are present. In preadolescent children, sexual abuse must be considered in cases of confirmed chlamydial infection. 

Chlamydial ophthalmia neonatorum is characterized by the onset of a mild to moderate unilateral or bilateral mucopurulent conjunctivitis 5 to 14 days postpartum (Figure 25-20). Eyelid edema, chemosis, and conjunctival membrane or pseudomembrane formation may also accompany this condition. Corneal findings occasionally include punctate opacities and micropannus formation. Ophthalmia neonatorum secondary to C. trachomatis was once considered a benign and self-limited condition. However, systemic chlamydial infection, especially pneumonitis, is now well recognized in patients with chlamydial conjunctivitis. More than 50% of infants who develop chlamydial pneumonitis may also have ophthalmia neonatorum. 

Chlamydial conjunctivitis. In the developed world, the genital (D-K) serotypes of the organism are responsible and the reservoir and transmission is maintained by sexual contact. Endemic trachoma in developing countries is usually caused by serotypes A, B and C. In either case, oral tetracycline is effective. Pregnant or lactating women may receive sys-teiiuc erythromycin. Neonatal ophthalmia should be treated with systemic erythromycin and topical tetracycline. 

Stenberg, K., and Mardh, R A. (1991). Treatment of chlamydial conjunctivitis in newborns and adults with erythromycin and roxithromycin. J. Antimicrob. Chemother. 28,301-307. 

Inclusion conjunctivitis A chlamydial infection that can result from self-inoculation with Chlamydia trachomatis. 

---