Pediatric emergency medicine trisk 2333 2333
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conjunctivitis is 14 days of erythromycin (50 mg/kg/day in four divided doses)
or a 3-day course of azithromycin (20 mg/kg/dose). The treatment of trachoma is
a single dose of azithromycin (20 mg/kg; maximum: 500 mg). In contrast,
topical therapy for chlamydia conjunctivitis is not recommended. Standard
precautions are recommended.
Gonorrhea, Neonatal
The most common site of neonatal gonorrheal infection is the eye (ophthalmia
neonatorum). While rare in the United States due to neonatal ocular prophylaxis,
it may occur if prophylaxis does not occur (e.g., children born in nonhospital
facilities) for children born to mothers with gonococcal chorioamnionitis. Infants
present within the first week of life (most commonly between days 2 and 5 of
life) with a hyperpurulent conjunctivitis. The diagnosis can be made by a Gram
stain of the exudate, which demonstrates gram-negative diplococci. Blood
cultures should be sent, as neonatal gonorrheal infections can involve the
meninges, joints, skin/soft tissue (e.g., from scalp electrodes), and bacteremia.
Nucleic acid amplification tests (NAATs) are FDA approved for male urethral
and female endocervical or vaginal swabs or urinary specimens; however,
NAATs are not FDA approved for the diagnosis of neonatal gonorrheal
conjunctivitis.
Prompt treatment and ophthalmologic evaluation are necessary to avoid the
recognized complications of corneal ulceration and iridocyclitis. The treatment
for ophthalmia neonatorum is a single dose (25 to 50 mg/kg, maximum 125 mg)
of ceftriaxone, administered intravenously or intramuscularly. This is also the
recommended treatment for asymptomatic infants born to mothers with untreated
gonorrhea. Antibiotic eye ointment is not adequate as monotherapy and not
beneficial when the child is receiving systemic therapy. For disseminated
disease, 7 to 14 days of intravenous cefotaxime or ceftriaxone are recommended.
Empiric treatment for chlamydia should be considered. Standard precautions are
recommended.
Gonorrhea, Disseminated
Disseminated gonococcal disease is rare, estimated to occur in 1% to 3% of all
untreated cases. The most common extragenital sites include skin and joints
(arthritis–dermatitis syndrome). The rash is polymorphous, but often
maculopapular or pustular painful lesions more commonly found on the
extremities than the trunk; they may involve the palms and soles. The rash may
have a hemorrhagic component. Joint complaints include a migratory
