Treatment of chlamydial conjunctivitis in neonates and children

For neonates with mucopurulent conjunctivitis suspected to be caused by Chlamydia trachomatis (eg presence of risk factors for chlamydial infection in birthing parent [eg mother]) in whom follow-up is likely to be difficult (eg in remote communities), take a conjunctival swab and consider starting empirical therapy for chlamydial conjunctivitis.

Refer neonates and children with chlamydial conjunctivitis to an ophthalmologist because corneal complications can occur.

Chlamydial conjunctivitis in a child may result from birthing parent-to-child (eg mother-to-child) transmission, accidental transmission or sexual abuse (see also STIs in children).

Chlamydial conjunctivitis requires systemic treatment. There is no evidence that concomitant topical therapy improves outcomesAustralian Society for Infectious Diseases (ASID), 2022.

While awaiting ophthalmology review, use:

Neonates with chlamydial conjunctivitis may have associated chlamydial pneumonia or can develop pneumonia if the chlamydial conjunctivitis is not cleared (see Pneumonia caused by Chlamydia trachomatis). Consider performing a test of cure using conjunctival and nasopharyngeal swab samples at least 4 weeks after completing conjunctivitis treatment in neonates to ensure that therapy has been adequateOng, 2022.

Treat the birthing parent of the infected neonate for C. trachomatis infection – for treatment regimens, management of sexual contacts and information on additional testing (including test of cure), see Approach to Chlamydia trachomatis infection.