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Treatment of gonococcal conjunctivitis with a single intramuscular injection of cefotaxime
P Lepage1, P Kestelyn, J Bogaerts
1Department of Paediatrics, Centre Hospitalier de Kigali, Rwanda.
Insights
Cefotaxime effectively treats gonococcal ophthalmia neonatorum in African infants, even with resistant strains. A single dose is recommended for high-prevalence areas, improving compliance and reducing costs.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Neisseria gonorrhoeae exposure at birth poses a significant risk for gonococcal ophthalmia neonatorum in African children.
- The prevalence of penicillinase-producing Neisseria gonorrhoeae (PPNG) strains complicates treatment options.
Purpose of the Study:
- To evaluate the efficacy of cefotaxime as a first-line treatment for gonococcal ophthalmia neonatorum.
- To assess the effectiveness of a single-dose intramuscular injection of cefotaxime.
Main Methods:
- A study involving 21 infants diagnosed with gonococcal conjunctivitis over 47 months.
- Nineteen infants received a single 100 mg/kg intramuscular injection of cefotaxime.
- Clinical cure and residual eye damage were assessed at follow-up examinations.
Main Results:
- All 21 patients achieved clinical cure without residual eye damage within 3 to 7 days.
- Twelve isolates were identified as PPNG strains, demonstrating cefotaxime's efficacy against resistant bacteria.
- 38% of patients had prior antibiotic exposure, highlighting the need for effective new treatments.
Conclusions:
- Cefotaxime is an effective first-line treatment for gonococcal ophthalmia neonatorum, particularly in regions with high PPNG prevalence.
- A single-dose regimen of cefotaxime offers advantages in compliance and cost-effectiveness compared to multidose treatments.
Abstract:
Between 25% and 50% of children in African countries are exposed to Neisseria gonorrhoeae at birth and are at risk of developing gonococcal ophthalmia neonatorum. The problem is aggravated by the emergence of penicillinase-producing strains of N. gonorrhoeae (PPNG). Twenty-one children (9 boys, 12 girls, mean age 13 days) presenting with gonococcal conjunctivitis were identified during a 47-month period. Nineteen children received a single im injection of 100 mg/kg cefotaxime (maximum dose 1 g) without topical antibiotic therapy. One neonate with concurrent otitis media was treated with cefotaxime for five days and a 17-month old girl received two im injections because of the severity of her symptoms. Eight patients (38%) had received previous antibiotic therapy (penicillin im and/or tetracycline eye ointment). Twelve isolates of N. gonorrhoeae were found to be PPNG strains. At three to seven day follow-up examination all 21 patients were clinically cured without residual eye damage. Cefotaxime offers an effective first line treatment for gonococcal ophthalmia neonatorum in areas where there is a high prevalence of PPNG strains. The advantages of a single-dose treatment over multidose regimens in terms of compliance and cost are discussed.