# Ophthalmia neonatorum (newborn conjunctivitis) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: StatPearls: Ophthalmia Neonatorum (NCBI Bookshelf NBK551572) · Egyptian National Drug Formulary, antimicrobial 2023, ceftriaxone monograph (printed p. 247) · No labelled dose - a procedure, not a medicine · Ophthalmia neonatorum - disease-level clinical article (ophthalmia-neonatorum-full.txt), Maternal and partner therapy, corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph, Dosage Regimen, Sexually transmitted infections) - Verified date: 2026-08 ## Verified against - StatPearls: Ophthalmia Neonatorum (NCBI Bookshelf NBK551572) - No labelled dose - a procedure, not a medicine - Ophthalmia Neonatorum - disease-level clinical article (ophthalmia-neonatorum-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (cefotaxime monograph, neonatal dosage) - Ophthalmia neonatorum - disease-level clinical article (ophthalmia-neonatorum-full.txt) - Ophthalmia neonatorum - disease-level clinical article (ophthalmia-neonatorum-full.txt), Maternal and partner therapy, corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph, Dosage Regimen, Sexually transmitted infections) ## Treatment metadata - Ceftriaxone — injection - Azithromycin — oral.liquid - Referral & safety-netting (no drug therapy) - Erythromycin — eye - Acyclovir — 250 mg — injection - Cefotaxime — injection - Saline eye irrigation - Azithromycin — 1000 mg — oral.solid ## Complete treatment card ```text OPHTHALMIA NEONATORUM (NEWBORN CONJUNCTIVITIS) Sources: StatPearls: Ophthalmia Neonatorum (NCBI Bookshelf NBK551572) · Egyptian National Drug Formulary, antimicrobial 2023, ceftriaxone monograph (printed p. 247) · No labelled dose - a procedure, not a medicine · Ophthalmia neonatorum - disease-level clinical article (ophthalmia-neonatorum-full.txt), Maternal and partner therapy, corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph, Dosage Regimen, Sexually transmitted infections) Review status: REVIEWED against StatPearls: Ophthalmia Neonatorum (NCBI Bookshelf NBK551572), No labelled dose - a procedure, not a medicine, Ophthalmia Neonatorum - disease-level clinical article (ophthalmia-neonatorum-clinical.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (cefotaxime monograph, neonatal dosage), Ophthalmia neonatorum - disease-level clinical article (ophthalmia-neonatorum-full.txt), Ophthalmia neonatorum - disease-level clinical article (ophthalmia-neonatorum- full.txt), Maternal and partner therapy, corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph, Dosage Regimen, Sexually transmitted infections) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Eye symptoms starting on day one or two after birth suggest a chemical reaction to prophylactic eye treatment or early gonococcal infection - Onset around days 3 to 7 is most consistent with gonococcal infection - Onset later, around days 5 to 14, is more typical of chlamydial infection - Poor feeding, irritability, or disturbed sleep can signal systemic illness or discomfort rather than eye disease alone [irritability · poor feeding] - Fever, lethargy, poor feeding, or breathing trouble raise concern that infection has spread beyond the eye [fever · lethargy · poor feeding] - Chlamydial disease often carries colonisation of the nose and throat and can go on to a middle ear infection - Herpes tends to arrive later, in the second week, with fever, irritability and blistering skin lesions [fever · irritability · skin lesions] SIGNS - what you find (8) - Thick purulent discharge with marked lid swelling and chemosis characterizes gonococcal conjunctivitis [eyelid swelling · pus] - Chlamydial infection starts with copious discharge that turns purulent, together with eyelid swelling [eyelid swelling · pus] - One-sided chemosis with blood-tinged discharge plus vesicles around the eyelids or mouth ulcers suggests herpes simplex [blisters · mouth ulcers · vesicles] - Small translucent follicles on the conjunctiva favor chlamydia, while raised vascular papillae favor bacterial infection - Corneal clouding, defects, or ulceration signal a risk of perforation, especially in gonococcal disease - Tough membranes on the conjunctiva that bleed when peeled off suggest chlamydial or severe bacterial infection - Enlarged lymph nodes in front of the ear are common with chlamydial and viral conjunctivitis [lymphadenopathy] - Chemical irritation from the prophylactic drops starts within hours of them and clears in a day or two with no antibiotic TESTS (6) - Gram stain and culture on Thayer-Martin and chocolate agar isolates gonococcus when it is suspected - PCR, direct fluorescent antibody staining, or Giemsa-stained scrapings help diagnose chlamydial infection - Viral culture and PCR for viral DNA confirm herpetic conjunctivitis - Culturing the blood together with a full cell count screens for bloodstream spread, especially when gonococcus is the suspected cause - PCR panels for gonorrhea, chlamydia, and HSV give a rapid, highly sensitive result within about 48 hours - Slit-lamp exam with a neonatal speculum can pick up corneal epithelial defects or dendritic lesions IF NOT THIS - what else fits (3) - A blocked tear duct causes watery eyes with little true discharge, unlike infective ophthalmia neonatorum - Staphylococcal conjunctivitis is also on the differential for neonatal eye discharge - Blepharitis is also considered in the differential for neonatal eye discharge Source StatPearls "Ophthalmia Neonatorum" - disease-level clinical article Status traced to the source above Rx: Gonococcal | Chlamydial | Main treatment | Prophylaxis at birth - no Egyptian product exists | Gonococcal - alternative when ceftriaxone is unavailable | Mother and sexual partner - chlamydial, to prevent reinfection GONOCOCCAL 1. CEFTRIAXONE [1st line] Adult Not applicable - a disease of the first month of life - Single dose Peds 25-50 mg/kg/dose [child max 125 mg] (25-50 mg/kg as a single intramuscular dose, never more than 125 mg.) 3kg -> 75-125 mg/dose (upper capped) 4kg -> 100-125 mg/dose (upper capped) 5kg -> 125 mg/dose (capped) 6kg -> 125 mg/dose (capped) 7kg -> 125 mg/dose (capped) 8kg -> 125 mg/dose (capped) 9kg -> 125 mg/dose (capped) 10kg -> 125 mg/dose (capped) 11kg -> 125 mg/dose (capped) 12kg -> 125 mg/dose (capped) 13kg -> 125 mg/dose (capped) 14kg -> 125 mg/dose (capped) 15kg -> 125 mg/dose (capped) 16kg -> 125 mg/dose (capped) 17kg -> 125 mg/dose (capped) 18kg -> 125 mg/dose (capped) 19kg -> 125 mg/dose (capped) 20kg -> 125 mg/dose (capped) 21kg -> 125 mg/dose (capped) 22kg -> 125 mg/dose (capped) 23kg -> 125 mg/dose (capped) 24kg -> 125 mg/dose (capped) 25kg -> 125 mg/dose (capped) 26kg -> 125 mg/dose (capped) 27kg -> 125 mg/dose (capped) 28kg -> 125 mg/dose (capped) 29kg -> 125 mg/dose (capped) 30kg -> 125 mg/dose (capped) 31kg -> 125 mg/dose (capped) 32kg -> 125 mg/dose (capped) 33kg -> 125 mg/dose (capped) 34kg -> 125 mg/dose (capped) 35kg -> 125 mg/dose (capped) 36kg -> 125 mg/dose (capped) 37kg -> 125 mg/dose (capped) 38kg -> 125 mg/dose (capped) 39kg -> 125 mg/dose (capped) 40kg -> 125 mg/dose (capped) 41kg -> 125 mg/dose (capped) 42kg -> 125 mg/dose (capped) 43kg -> 125 mg/dose (capped) 44kg -> 125 mg/dose (capped) 45kg -> 125 mg/dose (capped) 46kg -> 125 mg/dose (capped) 47kg -> 125 mg/dose (capped) 48kg -> 125 mg/dose (capped) 49kg -> 125 mg/dose (capped) 50kg -> 125 mg/dose (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source StatPearls: Ophthalmia Neonatorum (NCBI Bookshelf NBK551572) Why For gonococcal disease, which is the one that blinds. Purulent discharge with marked lid swelling in the first five days is gonococcal until proved otherwise, and it does not wait for a swab result. Caution Untreated gonococcal infection ulcerates and perforates the cornea, and it can do it within 24 to 48 hours of the discharge starting. This is a same-day referral, not a next-appointment one. NOT in a jaundiced newborn, and above all not a premature one: ceftriaxone displaces bilirubin from albumin. In a baby who is both jaundiced and infected, an alternative cephalosporin is needed and that choice belongs to whoever is admitting the child. Never alongside any intravenous calcium-containing fluid in a baby of 28 days or less. That combination has killed neonates. Do not give ceftriaxone intravenously in a solution containing lidocaine. Treat the mother and her partner. A newborn's gonococcal eye is a maternal genital infection that has not been dealt with, and without treating it the next baby gets the same thing. Egypt CEFAXONE 250MG I.V. VIAL. PHARCO B 15.00 EGP CEFOTRIX 250MG I.V.VIAL (U.S.P.23) UP PHARMA 15.00 EGP TRIXOMASH 500MG VIAL FOR I.V. INJ. RAMEDA > MASH PREMIERE 16.50 EGP TRIAXONE 500MG VIAL FOR I.M. INJ. TABUK PHARMACEUTICAL MANUFACTURING COM... 36.00 EGP WINTRIAXONE 1 GM PD. FOR I.M INJ. SANOFI 48.00 EGP CEFTRIAXONE-SANDOZ 500 MG I.M. VIAL PHARCO B > SANDOZ 62.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP CHLAMYDIAL 2. AZITHROMYCIN (liquid) [1st line] Adult Not applicable - a disease of the first month of life - Single dose, repeated after one week Peds 20 mg/kg/dose (20 mg/kg by mouth as a single dose, repeated once a week later. Erythromycin 50 mg/kg/day in 4 divided doses for 14 days is the alternative.) 3kg -> 60 mg/dose 4kg -> 80 mg/dose 5kg -> 100 mg/dose 6kg -> 120 mg/dose 7kg -> 140 mg/dose 8kg -> 160 mg/dose 9kg -> 180 mg/dose 10kg -> 200 mg/dose 11kg -> 220 mg/dose 12kg -> 240 mg/dose 13kg -> 260 mg/dose 14kg -> 280 mg/dose 15kg -> 300 mg/dose 16kg -> 320 mg/dose 17kg -> 340 mg/dose 18kg -> 360 mg/dose 19kg -> 380 mg/dose 20kg -> 400 mg/dose 21kg -> 420 mg/dose 22kg -> 440 mg/dose 23kg -> 460 mg/dose 24kg -> 480 mg/dose 25kg -> 500 mg/dose 26kg -> 520 mg/dose 27kg -> 540 mg/dose 28kg -> 560 mg/dose 29kg -> 580 mg/dose 30kg -> 600 mg/dose 31kg -> 620 mg/dose 32kg -> 640 mg/dose 33kg -> 660 mg/dose 34kg -> 680 mg/dose 35kg -> 700 mg/dose 36kg -> 720 mg/dose 37kg -> 740 mg/dose 38kg -> 760 mg/dose 39kg -> 780 mg/dose 40kg -> 800 mg/dose 41kg -> 820 mg/dose 42kg -> 840 mg/dose 43kg -> 860 mg/dose 44kg -> 880 mg/dose 45kg -> 900 mg/dose 46kg -> 920 mg/dose 47kg -> 940 mg/dose 48kg -> 960 mg/dose 49kg -> 980 mg/dose 50kg -> 1000 mg/dose AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source StatPearls: Ophthalmia Neonatorum (NCBI Bookshelf NBK551572) Why For chlamydial disease, the commoner cause and the later one - typically the second week, with less dramatic swelling. Ceftriaxone does not cover chlamydia at all, so a gonococcal dose alone leaves it untreated. Caution Chlamydia is not covered by ceftriaxone - the formulary says so explicitly. If both are possible, both need treating. Chlamydial conjunctivitis in a newborn means chlamydial pneumonia may follow weeks later. Warn the parents what a persistent staccato cough at 4 to 12 weeks means. Oral erythromycin in the first weeks of life is associated with pyloric stenosis - a reason to prefer the azithromycin regimen where there is a choice. The mother and her sexual partner need treating too, or the baby is reinfected - the article is firm that covering them at the same time is what stops it coming back, and gives her azithromycin 1 g by mouth. Their dose is the one listed under Mother and sexual partner - the newborn is dosed separately and must NOT be given it. Egypt ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP AZATRIBACT 200MG/5ML SUSP. 22.5 ML RIVA PHARMA S.A.E. 15.00 EGP AZI-ONCE 200MG/5ML SUSP. 22.5ML JAMJOOM PHARM... 34.00 EGP AZITHROTREAT 2GM/60ML PD. FOR ORAL SUSP. SIGMA > ANDALOUS PHARMA 44.00 EGP ZITHRODOSE 100MG/5ML SUSP. 60ML EL-OBOUR > AV... 62.00 EGP ZITHROMAX 900MG/22.5ML (200MG/5ML) SUSP. PFIZER 100.00 EGP ZITHROMAX 1200MG/30ML (200MG/5ML) SUSP. PFIZER 126.00 EGP AZOMYCIN 200MG/5ML SUSP. 15ML PHARCO 15.60 EGP -> ? strength differs, ? different route - not oral liquid GIGAZOCIN 200MG/5ML PD. ORAL SUSP. 25 ML T3A PHARMA > PIONEER 16.50 EGP -> ? strength differs, ? different route - not oral liquid MAIN TREATMENT - choose one, plus any add-on marked below 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Ophthalmia Neonatorum - disease-level clinical article (ophthalmia-neonatorum- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Gonococcal ophthalmia neonatorum requires hospitalization due to risk of systemic dissemination (arthritis, meningitis, sepsis). RED FLAG - Urgent ophthalmology referral is required when corneal involvement, pseudomembranes, or any threat to vision is identified. 4. ACYCLOVIR [2nd line] Adult IV: 10 mg/kg/dose every 8 hours. x 14 to 21 days Peds 20 mg/kg/dose (Neonates and children ≤3 months of age: 20 mg/kg every 8 hours given for 14 days for infections of skin, eyes, or mouth or 21 days for disseminated or CNS infections.) 3kg -> 60 mg/dose 4kg -> 80 mg/dose 5kg -> 100 mg/dose 6kg -> 120 mg/dose This mg/kg figure applies up to 6 kg only - above that, dose on specialist advice Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Systemic antiviral therapy for HSV conjunctivitis and ocular infection in newborns. Caution Hypersensitivity to acyclovir, valacyclovir, or any component of the formulation Acyclovir IV is an irritant (depending on concentration); avoid extravasation. Egypt SUPRAVIRAN 250MG I.V VIAL GRUNENTHAL-GE... 40.00 EGP ACICLOVIR VIATRIS 250 MG 5 VIALS REIG JOFRE > ... 530.00 EGP ACIGLOTIR 250 MG LYOPH. PD. FOR IV INF. 5 VIALS GLOBAL PHARMACEUTICAL IN... 530.00 EGP ZOVIRAX 250MG 5 I.V. INF. VIAL GLAXO SMITHKLINE 910.00 EGP 5. SALINE EYE IRRIGATION [add-on - not a substitute] Adult Irrigate the eye with sterile isotonic saline, repeated frequently until the discharge stops - Until the discharge settles Peds Frequent sterile saline irrigation, daily at least, until the eye stops discharging. Source No labelled dose - a procedure, not a medicine Why Washes away the purulent load while the antibiotic works. It treats nothing on its own. Caution An adjunct. Irrigation without a systemic antibiotic does not treat gonococcal disease and will not stop it perforating a cornea. PROPHYLAXIS AT BIRTH - NO EGYPTIAN PRODUCT EXISTS 6. ERYTHROMYCIN [1st line] Adult 0.5% ointment applied to both eyes within the first hour after birth Peds Applied to both eyes within the first hour after birth. Source Ophthalmia neonatorum (newborn conjunctivitis) - disease-level clinical article (ophthalmia-neonatorum-clinical.txt) Why Universal ocular prophylaxis at birth to prevent gonococcal and chlamydial ophthalmia neonatorum. Caution None of the three prophylaxis agents the source names can be bought in Egypt. Erythromycin 0.5% eye ointment has no Egyptian product of any kind, plain tetracycline 1% eye ointment has none, and povidone-iodine 2.5% ophthalmic solution has none - the only povidone eye products here are lubricants, not the antiseptic. The nearest thing a pharmacy will hand over is oxytetracycline with polymyxin B eye ointment. It is a different tetracycline at half the strength the source specifies, so it is a substitution to make deliberately and not the sourced regimen. Where prophylaxis cannot be given, what protects the baby is treating the mother's infection in pregnancy and treating a symptomatic newborn at once with ceftriaxone or azithromycin. Purulent discharge in the first days of life is gonococcal until proven otherwise and is a same-day sight-threatening emergency. Prophylaxis given at birth does not rule it out. Egypt AKNEMYCIN 2% OINT. 15 GM MUP > HERMAL-... 5.00 EGP -> ? different route - not eye, discontinued ACNI-CARE 2% TOP. GEL. 20 GM SIGMA 6.50 EGP -> ? different route - not eye, discontinued ERYTHROCID 200 MG/5ML SUSP. 60ML CID 5.60 EGP -> ? different route - not eye, discontinued ERYTHROMYCIN PHARCO 200MG/5ML SUSP. 60ML PHARCO 7.50 EGP -> ? different route - not eye, discontinued AKNEMYCIN 2% SOLUTION 25 ML MUP > HERMAL-... 9.00 EGP -> ? different route - not eye, discontinued ETHYRONATE 200MG/5ML SUSP. 100 ML UNIPHARMA CO. > UNIPHARMA 9.50 EGP -> ? different route - not eye, discontinued ETHYRONATE 400MG/5ML SUSP. 100 ML UNIPHARMA CO. > UNIPHARMA 11.75 EGP -> ? different route - not eye, discontinued ACNI-CARE 2% LOTION 25 ML SIGMA 20.00 EGP -> ? different route - not eye, discontinued GONOCOCCAL - ALTERNATIVE WHEN CEFTRIAXONE IS UNAVAILABLE 7. CEFOTAXIME [2nd line] Adult Not applicable - a disease of the first month of life Peds 50 mg/kg/dose (ENDF, general neonatal dosage: 0-1 week, 50 mg/kg IV every 12 hours; 1-4 weeks, 50 mg/kg IV every 8 hours.) 3kg -> 150 mg/dose 4kg -> 200 mg/dose 5kg -> 250 mg/dose This mg/kg figure applies up to 5 kg only - above that, dose on specialist advice AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (cefotaxime monograph, neonatal dosage) Why Ceftriaxone is the card's gonococcal agent and the disease article names cefotaxime 50 mg/kg IM or IV as its substitute when ceftriaxone is not available - a real situation in Egyptian practice. The ENDF's neonatal cefotaxime figure is the same 50 mg/kg at the same routes. Caution Hypersensitivity to cefotaxime, any component of the formulation, or other cephalosporins The 50 mg/kg figure is the ENDF's general neonatal dosage for cefotaxime; the ENDF's cefotaxime indication list does not itself name gonococcal conjunctivitis, and the link to this disease comes from the disease article. Egypt CEFAXIM 500MG VIAL EL NASR 9.00 EGP CEFOTAX (UP PHARMA) 250 MG VIAL UP PHARMA 10.50 EGP XORIN 250MG VIAL MUP 10.50 EGP CEFAUSE 500MG VIAL I.M/I.V. OTSUKA > BADR... 29.00 EGP OMNITAXIME 500 MG I.M./I.V.VIAL RAMEDA > BOST... 38.00 EGP CEFOTAXIME - EVA PHARMA 1 GM I.M./I.V. VIAL EVA PHARMA 47.50 EGP CLAFORAN 1 GM I.M/I.V. VIAL SANOFI 68.00 EGP RAMETAX 2 GM I.V./I.M VIAL RAMEDA 71.00 EGP MOTHER AND SEXUAL PARTNER - CHLAMYDIAL, TO PREVENT REINFECTION - give alongside 8. AZITHROMYCIN (tablet) [add-on - not a substitute] Adult 1 g orally as a single dose - given to the MOTHER and to her sexual partner, not to the baby - Single dose Peds NOT a paediatric row and not the baby's dose. The baby's azithromycin is 20 mg/kg as a single dose, repeated once a week later - see the Chlamydial row on this card. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Ophthalmia neonatorum - disease-level clinical article (ophthalmia-neonatorum-full.txt), Maternal and partner therapy, corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph, Dosage Regimen, Sexually transmitted infections) Why The card treated the baby and left the source of the infection untreated. One sentence in the card's own article carries both claims: treating the mother at the same time - azithromycin 1 g by mouth - along with her sexual partners, is essential if reinfection is to be prevented. The Egyptian formulary doses the same regimen for the same purpose, giving 1 g orally as a single dose for a sexually transmitted infection, alone or in combination, under an indication that names the treatment of urethritis and of cervicitis. The information was already on the card as a bare caution; it is now a row with a document behind it, under its own heading so it cannot be mistaken for the baby's dose. Caution THIS DOSE IS FOR THE MOTHER AND HER PARTNER, NOT THE NEWBORN. The article treats it as essential that she and her sexual partners are covered alongside the baby - azithromycin 1 g by mouth for her - because that is what prevents the infection returning. Follow-up - the article asks that both the mother and her sexual partner are retested and treated again where needed, which is what keeps the infection from coming back. Why it matters - left untreated, maternal gonorrhoea passes to the baby in more than 30% of cases and chlamydia in as many as 50%. That is the whole argument for screening and treating in pregnancy. CONTRAINDICATED where there is hypersensitivity to azithromycin itself, to erythromycin, to any other macrolide - the azalides and ketolides included - or to anything else in the product. Treat for gonorrhoea as well if that is what the baby has or if it cannot be excluded - this single dose covers chlamydia, and the article's regimen for the newborn's gonococcal disease is a cephalosporin. Egypt AZIROWA 1000 MG 2 F.C. TABS. AL ROWAD PHAR... 44.00 EGP (22.00/unit) ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)