You are in: eMedicine Specialties > Ophthalmology > INFECTIOUS DISEASE ChlamydiaArticle Last Updated: Nov 2, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD Mounir Bashour is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada Editors: Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital; Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences Author and Editor Disclosure Synonyms and related keywords: chlamydiae, Chlamydia trachomatis, Chlamydia psittaci, Chlamydia pneumoniae, C trachomatis, C psittaci, C pneumoniae, adult inclusion conjunctivitis, trachoma, paratrachoma, chronic follicular conjunctivitis, sexually transmitted disease, STD, genital chlamydial disease, gonorrhea INTRODUCTIONSection 2 of 10
  BackgroundChlamydiae are obligate intracellular organisms from bacteria that now comprise 3 species. They include the following: Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pneumoniae. C trachomatis, which is almost exclusively a human pathogen, includes the agents of classic trachoma (ie, serotypes A, B, Ba, C). It also includes the agents of inclusion conjunctivitis or paratrachoma (ie, serotypes D-K). The latter organisms infect the epithelium of mucoid surfaces and were once identified as the trachoma-inclusion conjunctivitis agents (TRIC). Serotypes L1, L2, and L3, the agents that infect tissues deeper to the epithelium and cause lymphogranuloma venereum, also are included. C trachomatis is the most common cause of chronic follicular conjunctivitis (ie, follicular conjunctivitis lasting for >16-28 d). The organism also causes 3 clinical syndromes, which include the following: trachoma, adult inclusion conjunctivitis, and neonatal conjunctivitis. Trachoma and neonatal conjunctivitis are discussed in other chapters so this discussion is restricted to adult inclusion conjunctivitis. Adult inclusion conjunctivitis results from C trachomatis serotypes D-K, causing chronic follicular conjunctivitis that can occur in adults or in the neonate. The adult disease is transmitted sexually or from hand-to-eye contact. Gonorrhea is the most common co-infection with adult inclusion conjunctivitis. Rarely, the adult disease is transmitted from eye-to-eye contact (eg, sharing mascara). PathophysiologyThe epidemiology of this disease revolves around sexual contact. Modes of transmission include orogenital activities, hand-to-eye spread of infective genital secretions, and even direct ejaculate into the eye.1 Although rare, eye-to-eye contact spread has been reported (eg, sharing mascara). The incubation period is 4-12 days. FrequencyUnited StatesIt is estimated that 1 in 300 patients who have genital chlamydial disease develop adult inclusion conjunctivitis. SexNo difference in frequency of disease between the sexes has been reported. AgeUsually, this condition is observed in the young sexually active population. It is most common in persons aged 15-35 years. CLINICALSection 3 of 10
History
Physical
CausesAdult inclusion conjunctivitis is a sexually transmitted disease. DIFFERENTIALSSection 4 of 10
Conjunctivitis, Allergic Conjunctivitis, Bacterial Conjunctivitis, Neonatal Conjunctivitis, Viral Contact Lens Complications Dacryocystitis Keratitis, Bacterial Keratoconjunctivitis, Epidemic Keratoconjunctivitis, Superior Limbic Molluscum Contagiosum Trachoma
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| Drug Name | Tetracycline (Sumycin) |
|---|---|
| Description | Mainly bacteriostatic; inhibits bacterial protein synthesis by binding to 30S and to some extent 50S ribosomal subunits. They also may alter cytoplasmic membrane leading to leakage of intracellular components such as nucleotides from the cell. |
| Adult Dose | 250-500 mg PO qid for 3-6 wk |
| Pediatric Dose | <8 years: Not established >8 years: 25 mg/kg/d PO divided bid/qid to a maximum 50 mg/kg/d for severe infections |
| Contraindications | Documented hypersensitivity; severe renal or hepatic dysfunction; pregnancy or lactation unless potential benefits to patient outweigh risk to the fetus or child; common infections in children <8-13 years |
| Interactions | May potentiate effects of oral anticoagulants (monitor PT and adjust dose accordingly); bioavailability of digoxin may increase in a small subset of patients (<10%); bioavailability of tetracycline decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate (give 1-2 h before or after anti-infective); concurrent use of methoxyflurane anesthesia and tetracyclines may seriously impair renal function, leading in some cases to death; tetracycline can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; bacteriostatic effects of tetracycline may interfere with bactericidal action of penicillin; antidiarrhea agents containing kaolin and pectin or bismuth subsalicylate may impair absorption of oral tetracyclines |
| Pregnancy | D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus |
| Precautions | Excessive systemic accumulation of the drug and liver toxicity may occur in renal impairment; when administered IV, tetracycline derivatives may cause burning at the injection site or phlebitis (administer slowly); avoid extravasation; photosensitivity may occur following exposure to sunlight; discontinue therapy at first sign of skin discomfort; superinfection may occur in prolonged therapy; acute Fanconi syndrome (nausea, vomiting, polyuria, polydipsia, albuminuria, glycosuria, aminoaciduria, hypophosphatemia, hypokalemia, and acidosis) may occur with outdated tetracyclines; in rare instances, oral tetracyclines have caused esophagitis and esophageal ulceration; in long-term therapy, periodic laboratory evaluation of organ systems, including hematopoietic, renal, and hepatic, recommended |
| Drug Name | Erythromycin (EES, Erythrocin, E-Mycin) |
|---|---|
| Description | Macrolide antibiotic; inhibits protein synthesis by binding reversibly to 50S ribosomal subunits of susceptible microorganisms. Effect may be either bacteriostatic or bactericidal depending on sensitivity of the microorganism and concentration of the drug. |
| Adult Dose | 250-500 mg tab PO qid for 3-6 wk Ointment: Apply tid for 2-3 wk |
| Pediatric Dose | 50 mg/kg PO divided qid for 3-6 wk Ointment: Apply tid for 2-3 wk |
| Contraindications | Documented hypersensitivity; estolate formulation of erythromycin is contraindicated in liver disease or dysfunction |
| Interactions | Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis |
| Pregnancy | C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus |
| Precautions | Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur |
| Drug Name | Clarithromycin (Biaxin) |
|---|---|
| Description | Exerts antibacterial action by binding to 50S ribosomal subunit of susceptible bacteria and suppressing protein synthesis. |
| Adult Dose | 250-500 mg PO qid for 3-6 wk |
| Pediatric Dose | 15 mg/kg/d PO divided q12h; not to exceed 1000 mg/d |
| Contraindications | Documented hypersensitivity; coadministration of pimozide |
| Interactions | Toxicity increases with coadministration of fluconazole and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, carbamazepine, ergot alkaloids, triazolam, HMG CoA-reductase inhibitors; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents |
| Pregnancy | D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus |
| Precautions | Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies |
| Drug Name | Azithromycin (Zithromax) |
|---|---|
| Description | Azalide subclass of macrolide antibiotics, derived from erythromycin. Acts by binding to 50S ribosomal subunit of susceptible microorganisms and, thus, interferes with microbial protein synthesis. Nucleic acid synthesis is not affected. |
| Adult Dose | 500 mg (2 250-mg cap) PO on d 1, followed by 250 mg (1 250-mg cap) qd on d 2-5; treatment for chlamydia is administered as a single 1 g dose in practice |
| Pediatric Dose | 10 mg/kg/d PO on d 1, followed by 5 mg/kg on d 2-5 |
| Contraindications | Documented hypersensitivity; hepatic impairment; do not administer with pimozide |
| Interactions | May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine |
| Pregnancy | B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals |
| Precautions | May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine |
| Drug Name | Doxycycline (Doryx, Bio-Tab, Vibramycin) |
|---|---|
| Description | Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Usual doses of doxycycline may be used in patients with impaired renal function. |
| Adult Dose | 100 mg PO bid for 3-6 wk |
| Pediatric Dose | >8 years: <45 kg: 4.4 mg/kg/d PO qd or divided bid given on first d, followed by maintenance dose of 2.2-4.4 mg/kg/d PO qd or divided bid >45 kg: Administer as in adults |
| Contraindications | Documented hypersensitivity; severe hepatic dysfunction; myasthenia gravis |
| Interactions | Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy |
| Pregnancy | D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus |
| Precautions | Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines |
Article Last Updated: Nov 2, 2007
