A newborn presents with bilateral purulent conjunctival discharge developing on day 3 of life. Gram stain shows Gram-negative diplococci. The most appropriate treatment is:

• A Topical erythromycin ointment
• B Oral acyclovir
• C Topical silver nitrate prophylaxis
• D Intravenous ceftriaxone ✓

Explanation

Gonococcal ophthalmia neonatorum (Neisseria gonorrhoeae, Gram-negative diplococci) requires systemic intravenous or intramuscular ceftriaxone because it rapidly perforates the cornea and disseminates. Topical antibiotics alone are inadequate. Silver nitrate is prophylactic only. Topical erythromycin is for chlamydial prophylaxis. Acyclovir is for herpes simplex, which presents later and shows multinucleated giant cells.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.