Pediatric emergency medicine trisk 2333 2333

conjunctivitis is 14 days of erythromycin (50 mg/kg/day in four divided doses) or a 3-day course of azithromycin (20 mg/kg/dose) The treatment of trachoma is a single dose of azithromycin (20 mg/kg; maximum: 500 mg) In contrast, topical therapy for chlamydia conjunctivitis is not recommended Standard precautions are recommended Gonorrhea, Neonatal The most common site of neonatal gonorrheal infection is the eye (ophthalmia neonatorum) While rare in the United States due to neonatal ocular prophylaxis, it may occur if prophylaxis does not occur (e.g., children born in nonhospital facilities) for children born to mothers with gonococcal chorioamnionitis Infants present within the first week of life (most commonly between days and of life) with a hyperpurulent conjunctivitis The diagnosis can be made by a Gram stain of the exudate, which demonstrates gram-negative diplococci Blood cultures should be sent, as neonatal gonorrheal infections can involve the meninges, joints, skin/soft tissue (e.g., from scalp electrodes), and bacteremia Nucleic acid amplification tests (NAATs) are FDA approved for male urethral and female endocervical or vaginal swabs or urinary specimens; however, NAATs are not FDA approved for the diagnosis of neonatal gonorrheal conjunctivitis Prompt treatment and ophthalmologic evaluation are necessary to avoid the recognized complications of corneal ulceration and iridocyclitis The treatment for ophthalmia neonatorum is a single dose (25 to 50 mg/kg, maximum 125 mg) of ceftriaxone, administered intravenously or intramuscularly This is also the recommended treatment for asymptomatic infants born to mothers with untreated gonorrhea Antibiotic eye ointment is not adequate as monotherapy and not beneficial when the child is receiving systemic therapy For disseminated disease, to 14 days of intravenous cefotaxime or ceftriaxone are recommended Empiric treatment for chlamydia should be considered Standard precautions are recommended Gonorrhea, Disseminated Disseminated gonococcal disease is rare, estimated to occur in 1% to 3% of all untreated cases The most common extragenital sites include skin and joints (arthritis–dermatitis syndrome) The rash is polymorphous, but often maculopapular or pustular painful lesions more commonly found on the extremities than the trunk; they may involve the palms and soles The rash may have a hemorrhagic component Joint complaints include a migratory