Neonatal Conjunctivitis | Ophthalmia Neonatorum | Pediatrics | 5-Minute Review

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[@sherifbatawy]

Ok with that being said, there is kinda physiological neonatal "conjunctivitis" that happens in the first few days of life without any chemical or microbial reasons and that's simply because of the natural lacrimal duct and canal stenosis of the babies. So there is a tendency of accumulation of secretions at the canthus or the palpebral fissure without any conjunctival redness. In that case we advise only irrigation with normal saline and cleaning with sterile gauze pads, as well as gentle massaging of the lacrimal ducts. It's usually self-limiting without any treatment unless it gets recurrent for > 2 days and/or conjunctival redness starts. In that case we start the antimicrobial ttt. Also (VERY IMPORTANT) JUST BEFORE starting any topical treatment one MUST obtain a swab/smear of the secretion/ conjunctiva for the micobiologic differentiation and only then start with the treatment. And I'll tell you we've seen all kinda bacteria there starting with E-Coli and ending with atypical bacteria. If the diagnosed bacteria are found to resistant against your antibiotic down the road, then you have to change to the right antibiotic according to the microbiological Resistogram.

[@WhyNot-si4pj]

Great piece of information & adding (neonatal lacrimal duct stenosis) to the differential diagnosis of (neonatal conjunctival discharge) deserves to be presented as a research paper in any respective international conference in order to be be considered as part of the differential diagnosis in modern text books ! Birth canal itself is a host of a wide array of microbes that are NOT essentially capable of producing " neonatal conjunctivitis " on their own ; yet antibiotic resistance is a major growing concern in the past 2 decades at least BUT that microbial diagnostic protocol you presented is NOT widely accepted at the present time & resistance towards either erythromycin or tetracycline are NOT that widespread !

[@sherifbatawy]

@@WhyNot-si4pj I agree with what you said. I’m based in Germany, where we usually treat the neonatal conjunctivitis with Gentamicin eyedrops/ ointment 3 times daily, both eyes for complete 7 days. Most of the times Gentamicin brings about a good rapid effect. One case I witnessed there was a combination of 3 different bacteria with not even minimal clinical improvement simply because 2 of them were resistant against Gentamicin. Then we gave Ofloxacin eyedrops a shot and it worked. There are current papers suggesting the usage of cortisone eyedrops in combination to the antimicrobial agent especially in resistant cases. Dunno if you ever use that combination too.

[@WhyNot-si4pj]

@@sherifbatawy Why don't you follow the US protocol of antibiotics for treatment of neonatal conjunctivitis ? Birth canal microbes had NOT yet developed resistance towards erythromycin & tetracycline so far ! Since the 1980s gentamicin & many other members of the aminoglycoside family of antibiotics had been reported to be ineffective against a host of microbes that developed RESISTANCE against them ! More research showed that bacterial resistance towards the antibiotic developed through biochemical modifications of the aminoglycoside's structure including phosphorylation , adenylation & acetylation . Moreover aminoglycosides are effective against a wide array of Gram -ve bacteria including Neisseria gonorrhea ; BUT have limited effect against atypical organisms including Chlamydia trachomatis ! Fluoroquinolones like ofloxacin cover the Chlamydia species . I believe that adding cortisone eye drops to the antimicrobial agent ; especially in resistant cases is a good choice because the anti inflammatory effects of steroids will help reduce the amount of conjunctival discharge & eventually reduce the volume of distribution (Vd) of antibiotics so they can rapidly reach their therapeutic concentrations !

[@sherifbatawy]

@@WhyNot-si4pj That’s because the most common bacteria causing pediatric conjunctivitis in Germany are Staphylo-, Strepto- or Pneumococci. Ofloxacin or Erythromycin are recommended as a broad spectrum antibiotics as well. In many cases Erythromycin brings about no improvement d.t. resistance, moreover it’s not so available as eyedrops for some weird reason! So erfahrungsgemäß (according to experience) you start with Gentamicin. The Germans have developed their own medical guidelines in every specialty and they take them so seriously. The guidelines are updated on regular basis according to new studies in German universities. It’s sometimes completely different from what I learned back in Egypt (American guidelines), which drove me crazy in my first couple of years of residency. With that said, I still read US guidelines for myself and it turns out so many here do too including my consultant when we argue about any topic, he goes like “the Amis do that, we don’t do that here!”

[@WhyNot-si4pj]

@@sherifbatawy " Most common bacteria causing pediatric conjunctivitis in Germany are Staphylo-, Strepto- or Pneumococci " ! All of these bacteria are Gram +ve , do you think that gentamicin or any other aminoglycoside is the first line of treatment of those organisms ? In case of neonatal conjunctivitis with such organisms ; a prenatal ampicillin is the best prophylaxis against developing that condition ! I believe the future of antimicrobial therapeutics worldwide is combinations of antibiotics from different classes to overcome the growing resistance against antibiotics because it's still hard now to find bacterial specie that developed resistance to several antibiotics .

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Is Neisseria Gonorrhea a pyogenic organism like staphylococcus aureus & streptococcus pyogenes to produce such profuse purulent discharge ?

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[@WhyNot-si4pj]

@@MedicosisPerfectionalis No doubt at all about that ! But did you get my question ?

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Can you elaborate?

[@WhyNot-si4pj]

@@MedicosisPerfectionalis Is Neisseria Gonorrhea a pyogenic organism ?

[@sherifbatawy]

@@WhyNot-si4pj Pyogenic Cocci: The pyogenic cocci are spherical bacteria that cause various suppurative (pus-producing) infections in animals. Included are the Gram-positive cocci Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae, and the Gram-negative cocci, Neisseria gonorrhoeae and N. meningitidis. Source: Todar’s Textbook of Bacteriology © Kenneth Todar, PhD

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