## Gonococcal Conjunctivitis — First-Line Management ### Clinical Presentation The presentation of acute bilateral purulent conjunctivitis with gram-negative diplococci (Neisseria gonorrhoeae) in a young adult is pathognomonic for gonococcal conjunctivitis. **Key Point:** Gonococcal conjunctivitis is a medical emergency because untreated infection can lead to corneal perforation, scarring, and blindness within 24–48 hours. ### Drug of Choice **Ceftriaxone 1 g IM single dose** is the gold standard first-line treatment for gonococcal conjunctivitis. | Feature | Ceftriaxone | Rationale | |---------|-------------|----------| | Route | IM (systemic) | Achieves high aqueous humour and tear concentrations | | Dose | 1 g single dose | Bactericidal; covers penicillin-resistant strains | | Spectrum | Gram-negative cocci | Excellent activity against N. gonorrhoeae | | Resistance | Low | Effective against PPNG and CMRNG | ### Adjunctive Therapy - **Topical fluoroquinolone** (e.g., ofloxacin or ciprofloxacin eye drops) 4–6 times daily for 7–10 days as adjunct to systemic therapy. - **Saline irrigation** of the conjunctival sac 3–4 times daily to remove discharge and reduce bacterial load. **High-Yield:** Systemic therapy is mandatory because topical antibiotics alone cannot achieve adequate concentrations in the anterior chamber and cannot prevent systemic dissemination. ### Why Systemic Ceftriaxone? 1. Penetrates the blood–aqueous barrier effectively. 2. Covers both susceptible and resistant strains of N. gonorrhoeae. 3. Prevents corneal involvement and systemic complications. 4. Single-dose regimen improves compliance. **Clinical Pearl:** Gonococcal conjunctivitis in neonates (ophthalmia neonatorum) also requires systemic ceftriaxone (25–50 mg/kg IV/IM single dose) to prevent serious systemic infection, including disseminated gonococcal infection (DGI). [cite:Harrison 21e Ch 137]
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