Neonatal gonococcal conjunctivitis is best treated with which intervention?

• A. Oral erythromycin.
• B. Topical antibiotic drops.
• C. Intravenous vancomycin.
• D. Intramuscular ceftriaxone 50 mg/kg.

Answer: (D)

Gonococcal conjunctivitis in a newborn must be treated systemically because Neisseria gonorrhoeae can invade the conjunctiva quickly and has the potential for systemic spread and severe eye damage. A single-dose intramuscular ceftriaxone provides reliable systemic and ocular tissue concentrations to eradicate the organism.

Topical antibiotic drops alone don’t reach bacteria in the deeper conjunctival tissues or prevent possible bacteremia, so they’re insufficient. Oral erythromycin isn’t reliably effective against gonorrhea in neonates, and vancomycin targets primarily Gram-positive organisms, not Neisseria gonorrhoeae. Therefore, the best option is intramuscular ceftriaxone at 50 mg/kg. (Note: coinfection with Chlamydia can occur and may require additional therapy as indicated.)