Neonatal ophthalmia caused by multidrug-resistant Neisseria gonorrhoeae

Since the introduction of Crede's prophylaxis the incidence of neonatal ophthalmia has been reduced dramatically. Because of eye irritation the administration of silver nitrate solution was replaced in many countries by antibiotics, e. g. tetracyclin or erythromycin. In Germany, eye prophylaxis is recommended, but can be carried out only with the parent's consent which is often refused. We report on a newborn infant with neonatal ophthalmia. After a poorly monitored pregnancy Crede's prophylaxis was declined after birth by the mother and both mother and child left the hospital four hours after delivery. Two days later the neonate presented with swollen eyelids, hyperemia and purulent discharge; a bacteriological swab was obtained by a pediatrician and an erythromycin ointment was immediately administered locally. The microbiological culture revealed a multidrug-resistant strain of N. gonorrhoeae. Socio-economic circumstances delayed the mandatory systemic therapy with a cephalosporin. Ophthalmological examination one week after treatment showed a cure without consequences. There has been a resurgence of gonorrhea and other sexually transmitted diseases worldwide. Therefore, more attention should be focused on ocular prophylaxis, especially for pregnant women with a low socio-economic status and inadequate prenatal care. Both silver nitrate solution and antibiotics have disadvantages. Povidone-iodine seems to be a promising alternative for the prevention of neonatal ophthalmia, without the risk of inducing adverse effects or drug resistance.