Treatment with erythromycin at 50 mg/kg per day for 14 days demonstrated better cure rates compared with azithromycin in neonates with chlamydial conjunctivitis, but more data are needed to compare these treatments, according to findings published in the Journal of the Pediatric Diseases Society.
“Newborn ocular prophylaxis has been found to be ineffective in protecting against chlamydial conjunctivitis. Several high-income countries have replaced it with routine prenatal screening and treatment of mothers with a sexually transmitted infection,” Holger Schünemann, MD, PhD, professor of medicine at McMaster University in Ontario, Canada, and colleagues wrote. “However, in countries where prenatal screening is not a common practice and maternal chlamydial infections are prevalent, chlamydial infection remains a common cause of [ophthalmia neonatorum].”
Schünemann and colleagues conducted a systematic review and meta-analysis of randomized and nonrandomized studies that evaluated the effects of erythromycin, azithromycin or trimethoprim in neonates with chlamydial conjunctivitis. Those three antimicrobials were marked as high priority for review by a WHO guideline panel, the researchers wrote, and although there are other treatment options for chlamydial conjunctivitis, erythromycin, azithromycin and trimethoprim are “used more widely in lower- and middle-income countries and there is an outstanding question about which of them should be used in practice.”
Overall, researchers found 12 studies with a total of 292 neonates, and they focused their meta-analysis on seven studies that used erythromycin at 50 mg/kg body weight per day for 14 days. Researchers observed a 96% clinical cure rate (95% CI, 94%-100%) and a 97% microbiological cure rate (95% CI, 95%-99%). Additionally, 14% (95% CI, 1%-28%) of the neonates experienced adverse gastrointestinal effects. Schünemann and colleagues reviewed one study comparing azithromycin at 20 mg/kg per day administered in a single dose and a 3-day course. They found the microbiological cure rate was 60% (95% CI, 27%-93%) and 86% (95% CI, 61%-100%), respectively.
Treatment compliance was reported in only two studies, the researchers said. Only one study reported on pyloric stenosis events — a condition that has been associated with both azithromycin and erythromycin in other research — and none of the neonates developed any signs or symptoms. Furthermore, no studies assessed the use of trimethoprim. The researchers cautioned that the certainty of evidence is “low to very low because of the risk of bias and the imprecision of the results across the studies.”
Schünemann and colleagues suggest that although the evidence shows a higher cure rate associated with erythromycin than with azithromycin, more data are needed to compare these treatments. Additionally, there are no published data for trimethoprim, and the researchers said there are several unanswered questions surrounding compliance and risk of pyloric stenosis.
“Overall, the results of our review provide a synthesis of the best available evidence for the treatment of neonatal chlamydial conjunctivitis,” the researchers wrote. – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.