Neonatal chlamydial conjunctivitis is treated with which therapy?

• A. Topical erythromycin ointment.
• B. Intravenous antibiotics.
• C. Oral erythromycin 30 to 50 mg/kg/day for 2 weeks.
• D. Observation only.

Answer: (C)

Neonatal chlamydial conjunctivitis signals a systemic infection that often involves the respiratory tract, so treatment must reach organisms beyond the eye. The best approach is systemic antibiotic therapy to eradicate the infection in multiple sites, not just the conjunctiva. Oral erythromycin given for about two weeks—30 to 50 mg/kg per day in divided doses for 14 days—addresses both conjunctival infection and potential pneumonitis, reducing the risk of ongoing disease. Topical therapy alone would miss organisms in the nasopharynx and lungs, intravascular antibiotics aren’t necessary for uncomplicated cases, and waiting without treatment can allow progression to pneumonia and prolonged infection.