Area Drug and Therapeutics Committee

Appendix 11A - Management of Neonatal

Also see NHS Fife Antibiotic Guidance for the Treatment of Community Managed Infections www.fifeadtc.scot.nhs.uk/formulary/support%20info/Primary%20Care%20Antibiotic%20Guidelines.pdf and the BNF for Children www.bnf.org for current treatments.

Mild Moderate to severe Little or no inflammation Inflammation with purulent discharge. Watery/sticky eyes

Frequent eye toilet may be all that is required.

If the condition settles, no further action is needed. If it doesn’t settle, continue as described next.

> Take swab for culture and sensitivities in usual transport media (charcoal) and chlamydia swab using the Remel® Chlamydia test kit. > Frequent eye toilet. > Consider starting empirical topical treatment with eye drops or ointment.

If gonococcus suspected (early > Ongoing treatment depending presentation 24 to 48 hours on swab results and clinical after birth) condition. > Ask for gram stain as well as > In severe/non resolving cases, culture. take throat and eye swabs for > Ensure prompt delivery to viral culture using the Remel® laboratory. Chlamydia test kit. > Assess neonate for systemic > Discuss with microbiology/ infection. ophthalmology. > Consider early and aggressive topical and parenteral antibiotic therapy.

Please note: Cleaning ’ eyes in sterile water or sterile saline would be optimal, especially if further swabbing/culture were to occur a day or two later but warm tap water is an acceptable alternative. • If chlamydia result positive see guidance below for management. • Chlamydial infection may be simultaneous to gonococcal infection and usually develops 5 to 12 days after birth. Author: Opthalmology Version No.: 1 Date: Feb. 2010 Review Date: Feb. 2014 Approved on behalf of NHS Fife by the Fife Area Drugs & Therapeutics Committee Date:Feb. 2010 Area Drug and Therapeutics Committee • The PCR method is very sensitive and should detect the chlamydia from the discharge. Simply swabbing the discharge should be adequate. • Topical treatment alone of gonococcus and chlamydia is inadequate. Appropriate systemic antibiotics are required. • Mothers and partner(s) require investigation/treatment/follow up/ contact tracing by Genitourinary Medicine if the cause is a sexually transmitted infection.

Treatment of Chlamydial Conjunctivitis

• is a relatively common genital infection, which is asymptomatic in the majority of women. Infants born to mothers with chlamydia l cervicitis have a one in two chance of being infected. • Neonatal chlamydial conjunctivitis usually presents as acute onset conjunctivitis with swelling and purulent discharge generally 5 to 19 days after birth. It usually begins as a unilateral process but often becomes bilateral. Untreated chlamydial conjunctivitis results in a chronic low-grade conjunctivitis, which usually resolves spontaneously after 8-12 months, but may cause scarring of the and . • It is important to detect and treat chlamydial eye infection; as untreated, the runs a one in five risk of developing chlamydial pneumonitis. • The infection will not be detected by the usual charcoal swab and will not respond to the usual therapy for bacterial conjunctivitis (although it may be temporarily suppressed by use of chloramphenicol ointment). • If chlamydial infection is suspected then it is important to take the appropriate swab using the Remel® Chlamydia test kit. These swabs are available from laboratory reception. Use the smaller of the two swabs. After taking the swab, insert it into the medium and break the swab shaft evenly at the scored line. Replace the cap and close tightly. Transport to the laboratory promptly. Where delay is envisaged please store in refrigerator. • Topical treatment alone is ineffective. A positive result would require treatment with oral 12.5mg/kg four times daily for 14 days. The mother and partner would also require investigation/treatment and should be referred by letter to Genitourinary Medicine.

Blocked tear duct

• Watery, intermittently sticky eyes in infants are often due to blocked tear ducts and do not require topical antibiotic treatment, unless the eye is red. Simple bathing is all that is needed. 95% of watery eyes will spontaneously settle by the age of 18 months.

Author: Opthalmology Version No.: 1 Date: Feb. 2010 Review Date: Feb. 2014 Approved on behalf of NHS Fife by the Fife Area Drugs & Therapeutics Committee Date:Feb. 2010