Abstract
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 β-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.
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References
Schaller UC, Klauss V. Is Crede’s prophylaxis for ophthalmia neonatorum still valid? Bull World Health Organ 2001; 79(3): 262–3
Foster A, Klauss V. Ophthalmia neonatorum in developing countries. N Engl J Med 1995; 332(9): 600–1
van Bogaert LJ. Ophthalmia neonatorum revisited. Afr J Reprod Health 1998; 2(1): 81–6
Mohile M, Deorari AK, Satpathy G, et al. Microbiological study of neonatal conjunctivitis with special reference to Chlamydia trachomatis. Indian J Ophthalmol 2002 Dec; 50(4): 295–9
Crede CSF. Die Verhütung der Augentzündung der Neugeborenen [prevention of inflammatory eye disease in the newborn]. Archiv für Gynachologie 1881; 17: 50–3
Zola EM. Evaluation of drugs used in the prophylaxis of neonatal conjunctivitis. Drug Intell Clin Pharm 1984; 18(9): 692–6
Gerbase AC, Rowley JT, Mertens TE. Global epidemiology of sexually transmitted diseases. Lancet 1998; 351Suppl. 3: 2–4
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance, 2002. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, 2003 Sep
Macmillan S, McKenzie H, Flett G, et al. Which women should be tested for Chlamydia trachomatis? BJOG 2000; 107(9): 1088–93
Canadian Task Force on the Periodic Health Examination. 1992 update: 4. Prophylaxis for gonococcal and chlamydial opthalmia neonatorum. CMAJ 1992; 147(10): 1449–54
American Academy of Pediatrics. Chlamydial infections. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 238–43
Jain S. Perinatally acquired Chlamydia trachomatis associated morbidity in young infants. J Matern Fetal Med 1999; 8(3): 130–3
Mardh PA. Influence of infection with Chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring. Best Pract Res Clin Obstet Gynaecol 2002; 16(6): 847–64
McGregor JA, French JI. Chlamydia trachomatis infection during pregnancy. Am J Obstet Gynecol 1991; 164: 1782–9
Givner LB, Rennels MB, Woosward CL, et al. Chlamydia trachomatis infection in infants delivered by cesarean section. Pediatrics 1981; 68: 420–1
Medici A, Sollecito D, Rossi D, et al. Family outbreak of Chlamydia trachomatis [letter]. Lancet 1988; II(8612): 682
Sandstrom I. Neonatal conjunctivitis caused by Chlamydia trachomatis. Acta Otolaryngol Suppl 1984; 407: 67–9
Stenberg K, Mårdh PA. Chlamydial conjunctivitis in newborns and adults: history, clinic and follow-up of 133 cases. Acta Opthalmol (Copenh) 1990; 68: 651–7
Hammerschlag MR. Chlamydia trachomatis and Chlamydia pneumoniae infections in children and adolescents. Pediatr Rev 2004; 25(2): 43–51
Zar HJ, Van Dyk A, Yeats JK, et al. Chlamydia trachomatis lower respiratory tract infection in infants. Ann Trop Paediatr 1999; 19(1): 9–13
Were FN, Govedi AF, Revathi G, et al. Chlamydia as a cause of late neonatal pneumonia at Kenyatta National Hospital, Nairobi. East Afr Med J 2002 Sep; 79(9): 476–9
Colarizi P, Chiesa C, Pacifico L, et al. Chlamydia trachomatis-associated respiratory disease in the very early neonatal period. Acta Paediatr 1996; 85(8): 991–4
Sollecito D, Midulla M, Bavastrelli M, et al. Chlamydia trachomatis in neonatal respiratory distress of very preterm babies: biphasic clinical picture. Acta Paediatr 1992; 81(10): 788–91
Numazaki K, Asanuma H, Niida Y. Chlamydia trachomatis infection in early neonatal period. BMC Infect Dis 2003; 3(1): 2
Hammerschlag MR. Chlamydia trachomatis in children. Pediatr Ann 1994; 23(7): 349–53
Bell TA, Stamm WE, Wang SP, et al. Chronic Chlamydia trachomatis infections in infants. JAMA 1992; 267(3): 400–2
Weiss SG, Newcomb RW, Beem MO. Pulmonary assessment of children after chlamydial pneumonia of infancy. J Pediatr 1986; 108: 639–64
Harrison HR, Taussig LM, Fulginetti VA. Chlamydia trachomatis and chronic respiratory disease in childhood. Pediatr Infect Dis 1982; 1: 29–33
Locksmith G, Duff P. Infection, antibiotics and preterm delivery. Semin Perinatal 2001; 25(5): 295–309
Numazaki K, Chiba S, Kogawa K, et al. Chronic respiratory disease in premature infants caused by Chlamydia trachomatis. J Clin Pathol 1986; 39(1): 84–8
Isenberg SJ, Apt L, Wood M. A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum. N Engl J Med 1995; 332(9): 562–6
Assadian O, Assadian A, Aspock C, et al. Prophylaxis of ophthalmia neonatorum: a nationwide survey of the current practice in Austria. Wien Klin Wochenschr 2002; 114(5–6): 194–9
Isenberg SJ, Apt L, Yoshimori R, et al. Povidone-iodine for ophthalmia neonatorum prophylaxis. Am J Ophthalmol 1994; 118: 701–6
Hammerschlag MR, Chandler JW, Alexander ER, et al. Erythromycin ointment for ocular prophylaxis of neonatal chlamydial infection. JAMA 1980; 244(20): 2291–3
Hammerschlag MR, Cummings C, Roblin PM, et al. Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis. N Engl J Med 1989; 320(12): 769–72
Bell TA, Sandstrom KI, Gravett MG, et al. Comparison of ophthalmic silver nitrate solution and erythromycin ointment for prevention of natally acquired Chlamydia trachomatis. Sex Transm Dis 1987; 14(4): 195–200
Black-Payne C, Bocchini Jr JA, Cedotal C. Failure of erythromycin ointment for postnatal ocular prophylaxis of chlamydial conjunctivitis. Pediatr Infect Dis J 1989; 8(8): 491–5
Alexander ER, Harrison HR. Role of Chlamydia trachomatis in perinatal infection. Rev Infect Dis 1983; 5: 713–9
Zanoni D, Isenberg SJ, Apt L. A comparison of silver nitrate with erythromycin for prophylaxis against ophthalmia neonatorum. Clin Pediatr (Phila) 1992; 31(5): 295–8
Chen JY. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis. Pediatr Infect Dis J 1992; 11: 1026–30
Bell TA, Grayston T, Krohn MA, et al. Randomized trial of silver nitrate, erythromycin and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal opthalmitis. Pediatr 1993; 92(6): 755–60
Laga M, Plummer FA, Piot P, et al. Prophylaxis of gonococcal and chlamydial ophthalmia neonatorum: a comparison of silver nitrate and tetracycline. N Engl J Med 1988; 318: 653–7
Mårdh PA. Chlamydia screening: yes, but of whom, when and by whom and with what? Ann N Y Acad Sci 2000; 900: 286–92
Magriples U, Copel JA. Can risk factor assessment replace universal screening for gonorrhoea and chlamydia in the third trimester. Am J Perinatol 2001; 18: 465–8
Schachter J, Sweet RL, Grossman M, et al. Experience with the routine use of erythromycin for chlamydial infections in pregnancy. N Engl J Med 1986; 314(5): 276–9
Gray RH, Wabwire-Mangen F, Kigozi G, et al. Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, Uganda. Am J Obstet Gynecol 2001; 185(5): 1209–17
Mangione-Smith R, O’Leary J, McGlynn EA. Health and cost-benefits of chlamydia screening in young women. Sex Transm Dis 1999; 26(6): 309–16
Honey E, Augood C, Templeton A, et al. Cost effectiveness of screening for Chlamydia trachomatis: a review of published studies. Sex Transm Infect 2002; 78(6): 406–12
Rivlin ME, Morrison JC, Grossman III JH. Comparison of pregnancy outcome between treated and untreated women with chlamydial cervicitis. J Miss State Med Assoc 1997; 38(11): 404–7
Brockelhurst P, Rooney G. Interventions for treating genital Chlamydia trachomatis infection in pregnancy. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2002
Samson L, MacDonald NE. Management of infants born to mothers who have chlamydia infection. Pediatr Infect Dis J 1995; 14(5): 407–8
Hauben M, Amsden GW. The association of erythromycin and infantile hypertrophic pyloric stenosis: causal or coincidental? Drug Saf 2002; 25(13): 929–42
Mahon BE, Rosenman MB, Kleiman MB. Maternal and infant use of erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis. J Pediatr 2001; 139(3): 380–4
Klein JO. History of macrolide use in pediatrics. Pediatr Infect Dis J 1997; 16(4): 427–31
Fanos V, Dall’Agnola A. Antibiotics in neonatal infections: a review. Drugs 1999; 58: 405–27
Patamasucon P, Rettig PJ, Faust KL, et al. Oral vs topical erythromycin therapies for chlamydial conjunctivitis. Am J Dis Child 1982; 136(9): 817–21
Sandstrom I. Treatment of neonatal conjunctivitis. Arch Ophthalmol 1987; 105(7): 925–8
Rees E, Tait IA, Hobson D, et al. Persistence of chlamydial infection after treatment for neonatal conjunctivitis. Arch Dis Child 1981; 56(3): 193–8
Heggie AD, Jaffe AC, Stuart LA, et al. Topical sulfacetamide vs oral erythromycin for neonatal chlamydial conjunctivitis. Am J Dis Child 1985; 139(6): 564–6
Stenberg K, Mardh PA. Lack of efficacy of fusidic acid in the treatment of chlamydial conjunctivitis. Eur J Clin Microbiol Infect Dis 1990 Jan; 9(1): 57–8
Stenberg K, Mårdh PA. Treatment of chlamydial conjunctivitis in newborns and adults with erythromycin and roxithromycin. J Antimicrob Chemother 1991; 28(2): 301–7
Martin DH, Mroczkowski TF, Dalu ZA, et al. A controlled trial of a single-dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. N Engl J Med 1992; 327: 921–5
Reed MD, Blumer JL. Azithromycin: a critical review of the first azilide antibiotic and its role in pediatric practice. Pediatr Infect Dis J 1997; 16: 1069–83
Guay DRP. Macrolide antibiotics in paediatric infectious diseases. Drugs 1996; 51: 515–36
Singh J, Burr B, Stringham D, et al. Commonly used antibacterial and antifungal agents for hospitalised paediatric patients: implications for therapy with an emphasis on clinical pharmacokinetics. Paediatr Drugs 2001; 3(10): 733–61
Hammerschlag MR, Gelling M, Roblin PM, et al. Treatment of neonatal chlamydial conjunctivitis with azithromycin. Pediatr Infect Dis J 1998; 17(11): 1049–50
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Funding from the Medical Research Council (MRC) South Africa is acknowledged. The author has no conflicts of interest that are directly relevant to the content of this review.
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Zar, H.J. Neonatal Chlamydial Infections. Pediatr-Drugs 7, 103–110 (2005). https://doi.org/10.2165/00148581-200507020-00003
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DOI: https://doi.org/10.2165/00148581-200507020-00003