ro13-9904 and Ophthalmia-Neonatorum

By culturing for N gonorrhoeae in cases of neonates and children with conjunctivitis, vaginitis, urethritis, proctitis, sepsis, and arthritis, gonococcal infections can be identified easily. They are then treated with ceftriaxone. In neonates, the mother and her sexual contacts also should be treated. In children, a full evaluation for sexual contacts, with the assistance of other professionals, if necessary, will almost always identify a sexual contact. Appropriate action then can be taken to protect the child from further sexual contact. .

Topics: Abscess; Ceftriaxone; Child; Child, Preschool; Conjunctivitis; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Mouth Diseases; Ophthalmia Neonatorum; Pelvic Inflammatory Disease; Pharyngeal Diseases; Proctitis; Scalp Dermatoses; Urethritis; Vaginitis

A review is given of the selection and rational of optimal treatment regimens for patients with sexually transmitted pathogens, e.g. in cases of gonorrhea, chlamydial infections, chancroid, syphilis, pelvic inflammatory diseases and ophthalmia neonatorum. The scientific basis for the selection of a beta-lactam agent is discussed, including dose, MIC, the critical serum level and maintenance interval, and the duration of therapy. Except in the case of penicillinase-producing Neiserria gonorrhoeae, penicillin remained until recently the most effective agent available against many sexually transmitted diseases. However, ceftriaxone, a new third-generation cephalosporin, has been shown to have a long half-life (8 h) and excellent in vitro efficacy against Neiserria gonorrhoeae (including penicillinase-producing strains) and Haemophilis ducreyi. In view of its exceptional clinical efficacy against both gonorrhea and chancroid, clinical studies of its efficacy against other sexually transmitted diseases appear warranted.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Chancroid; Chlamydia Infections; Female; Gonorrhea; Humans; Infant, Newborn; Male; Ophthalmia Neonatorum; Pelvic Inflammatory Disease; Penicillins; Sexually Transmitted Diseases; Syphilis; Time Factors; Urethritis

We conducted a randomized clinical trial comparing a single intramuscular dose of 125 mg of ceftriaxone with a single intramuscular dose of 75 mg of kanamycin followed by topical gentamicin for seven days, and with a single intramuscular dose of 75 mg of kanamycin followed by topical tetracycline for seven days, in the treatment of gonococcal ophthalmia neonatorum in Nairobi, Kenya. Of 122 newborns with culture-proved gonococcal ophthalmia neonatorum, 105 returned for follow-up. Sixty-one infants (54 percent) received ceftriaxone, 32 received kanamycin plus topical gentamicin, and 29 received kanamycin plus topical tetracycline. Sixty-six (54 percent) of the Neisseria gonorrhoeae isolates were penicillinase producing. All 55 newborns who received ceftriaxone and returned for follow-up were clinically and microbiologically cured. One of 26 returning newborns who received kanamycin plus tetracycline and 2 of 24 returning newborns who received kanamycin plus gentamicin had persistent or recurrent gonococcal conjunctivitis. Ceftriaxone also eradicated oropharyngeal gonococcal infection in 18 newborns, whereas oropharyngeal infection persisted in 2 of 8 newborns who had received kanamycin (P not significant). We conclude that 125 mg of ceftriaxone as a single intramuscular dose is very effective therapy for gonococcal ophthalmia neonatorum, with marked efficacy against extraocular infection and without the need for concomitant topical antimicrobial therapy.

Topics: Ceftriaxone; Clinical Trials as Topic; Drug Resistance, Microbial; Follow-Up Studies; Gentamicins; Humans; Infant, Newborn; Injections, Intramuscular; Kanamycin; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Random Allocation; Tetracycline

A baby born at home 14 hours earlier was brought to the neonatology department with bilateral upper palpebral chemosis with purulent secretions and pseudomembranes, with no general signs of infection. The gram staining of a secretion sample shows the presence of Neisseria gonorrhoeae. Intramuscular ceftriaxone treatment was initiated, combined with topical application of rifamycin, dexamethasone, and oxytetracycline. Complete healing without sequelae was obtained after two weeks. This case presents an opportunity to review this preventable pathology and its treatment. The only effective way to prevent it is to raise the awareness of disadvantaged population about the value of antenatal care.

Topics: Anti-Bacterial Agents; Ceftriaxone; Dexamethasone; Female; Glucocorticoids; Humans; Infant, Newborn; Ophthalmia Neonatorum; Oxytetracycline; Rifamycins

To report the prevalence of gonococcal conjunctivitis (GC) presenting to a tertiary referral maternity hospital (NMH) and a tertiary referral ophthalmic hospital (RVEEH) from 2011 to 2013 and describe the demographics, clinical presentation, and antibiotic susceptibility of Neisseria gonorrhoeae ocular infections.. Demographic, clinical, and microbiological data were collected from patients with laboratory confirmed GC.. There were 27 556 live births at NMH during the study period, and no case of neonatal GC was identified. Fourteen cases of GC were identified at RVEEH in this period, representing a prevalence of 0.19 cases per 1000 eye emergency attendees. Antibiotic susceptibility data were available on nine cases, of which, all were ceftriaxone- and ciprofloxacin sensitive. 64.3% of patients were male, with a mean age of 18 years. The mean duration of symptoms was 3 days. All patients presented with unilateral conjunctival injection and purulent discharge. Eight cases had visual impairment at presentation and their mean visual acuity was 6/15. Corneal involvement was present in 25% of patients. Uveitis was not detected. On receipt of positive culture and/or PCR results, treatment was altered in two thirds of patients. All patients were referred for full STI screening and all patients showed a full clinical recovery 1 week posttreatment.. We observed that GC presented in young adults with a male predominance and was rare in neonates. In cases of unilateral purulent conjunctivitis, there should be a high clinical suspicion of GC, early swab for PCR and culture, and knowledge of current CDC-recommended antibiotic guidelines.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Conjunctivitis, Bacterial; Eye Infections, Bacterial; Female; Gonorrhea; Hospitals, Maternity; Hospitals, Special; Humans; Ireland; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Ophthalmology; Polymerase Chain Reaction; Prevalence; Young Adult

Ophthalmia neonatorum in small babies is a common problem in neonatal units in Al Ain, but is infrequently associated with sexually transmitted disease agents. A study of 81 babies with ophthalmia neonatorum showed that 81.5% had bacterial or fungal infections. Staphylococcus aureus was the commonest causative organism followed by Escherichia coli and Pseudomonas aeruginosa while Chlamydia trachomatis and Neisseria gonorrhoeae were responsible for less than 5% of all cases. The disease was predominantly mild to moderately severe and easily treated with topical broad-spectrum antibiotic agents which are effective against Gram-positive and Gram-negative bacteria, including hospital-associated strains. The most effective antimicrobial agents were gentamicin topically or ceftriaxone systemically.. Neonatal conjunctivitis is common in many developing countries, often due to a sexually transmitted disease (STD) such as Chlamydia trachomatis and Neisseria gonorrhoea. The prevention of ophthalmia neonatorum (ON) depends considerably upon knowledge of the type and incidence of the causative organisms, just as the recommended treatment protocols for ON vary according to the local causative microorganisms and their sensitivity to available antimicrobial agents. ON is a common problem in the neonatal units of Al Ain, but infrequently associated with STD agents. A study found 81.5% of 81 babies with ON to have either bacterial or fungal infections. Staphylococcus aureus was the most common causative organism followed by Escherichia coli and Pseudomonas aeruginosa. Chlamydia trachomatis and Neisseria gonorrhoea were responsible for less than 5% of all cases. The disease was mainly mild to moderately severe and easily treated with topical broad-spectrum antibiotic agents effective against Gram-positive and Gram-negative bacteria, including hospital-associated strains. The most effective antimicrobial agents were gentamicin topically and ceftriaxone systemically.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Cephalosporins; Conjunctiva; Eye Infections, Bacterial; Eye Infections, Fungal; Female; Gentamicins; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant, Newborn; Male; Microbial Sensitivity Tests; Ophthalmia Neonatorum; Prevalence; Treatment Outcome; United Arab Emirates

Topics: Cefotaxime; Ceftriaxone; Gonorrhea; Humans; Infant, Newborn; Injections, Intramuscular; Ophthalmia Neonatorum

Gonorrhea is the most common reportable disease in the United States. In recent years, the epidemiology of this infection has changed as a result of increasing drug abuse, exchange of money and drugs for sex, and sexual promiscuity among teenagers, particularly blacks. Significant numbers of asymptomatic male carriers have been identified, which presents an additional challenge to disease control. Gonococcal infection has become increasingly resistant to traditional antibiotic therapy and now requires the use of newer, more expensive agents. Single-dose oral treatment with cefixime (Suprax) or a quinolone appears to be effective, safe, and practical for patients with uncomplicated gonorrhea. Serious infection and new syndromes caused by gonococci continue to be reported. Because disseminated infections can be fatal, hospitalization and treatment with intravenous antibiotics such as ceftriaxone sodium (Rocephin) or cefotaxime sodium (Claforan) are required.

Topics: Adolescent; Black or African American; Ceftriaxone; Doxycycline; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Infant, Newborn; Male; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Spectinomycin; United States

Topics: Ceftriaxone; Colostrum; Humans; Infant, Newborn; Ophthalmia Neonatorum; Silver Nitrate

Topics: Ceftriaxone; Humans; Infant, Newborn; Ophthalmia Neonatorum

Topics: Ceftriaxone; Developing Countries; Humans; Infant, Newborn; Legislation, Medical; Ophthalmia Neonatorum; Silver Nitrate; United States