Topical sulfacetamide vs oral erythromycin for neonatal chlamydial conjunctivitis
A. D. Heggie, A. C. Jaffe, L. A. Stuart, P. S. Thombre and R. U. Sorensen
Conjunctival and nasopharyngeal cultures for Chlamydia trachomatis were
obtained from infants 30 days of age or younger with purulent
conjunctivitis. Conjunctival specimens were also tested for other bacterial
pathogens and for viruses. Most of the infants studied were black and came
from a low-income, urban population. By random assignment infants received
either topical treatment with 10% sulfacetamide sodium ophthalmic solution
or systemic treatment with oral erythromycin estolate (50 mg/kg/day).
Treatment was continued for 14 days if C trachomatis was isolated from the
conjunctivae. Treatment was considered to be effective if conjunctivitis
resolved and if follow-up chlamydial cultures of the conjunctivae and
nasopharynx were negative at completion of therapy and two to four weeks
later. Chlamydia trachomatis was isolated in the absence of other pathogens
from the eyes of 37 (73%) of 51 infants with conjunctivitis. Other
bacterial pathogens were isolated from four infants (8%) and viruses from
none. Chlamydial infection was eradicated from 14 (93%) of 15 infants
treated orally. In contrast, persistent conjunctival infection was detected
in eight infants (57%) and nasopharyngeal colonization in three (21%) of 14
infants after topical treatment. It was concluded that C trachomatis is the
most frequent cause of neonatal conjunctivitis in the low-income, urban
population studied; that erythromycin estolate administered orally for 14
days eradicates chlamydial conjunctival and nasopharyngeal infection; and
that topical sulfacetamide therapy may result in persistent conjunctival
infection and nasopharyngeal colonization.
