Neonatal chlamydial
infection, which manifests principally as
ophthalmia neonatorum (ON) or
pneumonia, is a significant cause of neonatal morbidity. Widespread use of
silver nitrate drops resulted in a dramatic decline in the incidence of gonococcal
ophthalmia but had much less impact on the incidence of neonatal chlamydial
infection. Chlamydia trachomatis has become the most common infectious cause of ON in developed countries.A number of prophylactic
antibiotic or
antiseptic agents have been used to prevent ON. Prophylaxis with 1%
silver nitrate ophthalmic drops, 0.5%
erythromycin ophthalmic
ointment, or 1%
tetracycline ointment has comparable efficacy for the prevention of chlamydial
ophthalmia but does not offer protection against nasopharyngeal colonization or the development of
pneumonia.
Erythromycin or
tetracycline topically have been used as prophylactic agents because of their allegedly superior activity for the prevention of ON and because they produced less chemical
conjunctivitis compared with
silver nitrate. However, the relative efficacy of these agents for chlamydial
infection and the emergence of
beta-lactamase-producing Neisseria gonorrheae has raised questions regarding their effectiveness when applied topically for prophylaxis of ON. Compared with these agents, a 2.5%
povidone-iodine ophthalmic solution has been found to have greater efficacy for the prevention of ON generally, and chlamydial
ophthalmia specifically. In countries where the incidence of ON is very low, an alternative strategy is to institute prenatal screening and treatment of infected mothers, forgo routine neonatal prophylaxis, and follow-up infants after birth for the possible development of
infection. For the treatment of chlamydial
ophthalmia or
pneumonia, oral
erythromycin for 2 weeks is recommended; additional topical
therapy is unnecessary. However, in approximately 20-30% of infants,
therapy will not eradicate the organism and the infant may require a repeat oral course of
antibiotics. The few published studies on the use of the new oral
macrolide antibiotics, such as
azithromycin,
roxithromycin, or
clarithromycin for chlamydial
infections in neonates suggest that these agents may be effective; however, more data on their tolerability and efficacy in this patient group are warranted.