From the Guidelines
Pertussis treatment should primarily involve antibiotics, with azithromycin being the preferred choice, given as a 5-day course (10 mg/kg on day 1, then 5 mg/kg on days 2-5) for children or 500 mg on day 1 followed by 250 mg on days 2-5 for adults, as it is the most effective and well-tolerated option, according to the most recent and highest quality study 1.
Key Considerations
- The choice of antimicrobial agent should take into account effectiveness, safety, tolerability, ease of adherence, and cost, with macrolides being the first-line therapy 1.
- Azithromycin is preferred over erythromycin and clarithromycin due to its better side-effect profile and higher tissue concentrations, allowing for less frequent administration and shorter treatment regimens 1.
- Treatment should begin as soon as pertussis is suspected, ideally within the first 1-2 weeks of symptoms, to reduce transmission and minimize the risk of complications 1.
- Supportive care, including maintaining hydration, managing coughing episodes, and monitoring for complications like apnea in infants, is crucial in addition to antibiotic therapy 1.
Alternative Options
- Clarithromycin (15 mg/kg/day divided twice daily for 7 days) or erythromycin (40-50 mg/kg/day divided four times daily for 14 days) may be considered as alternative options, although they have a higher risk of side effects and interactions compared to azithromycin 1.
- Trimethoprim-sulfamethoxazole may be used as an alternative agent in patients who cannot tolerate macrolides, although its effectiveness and safety profile are not as well-established 1.
Special Considerations
- In infants under 1 month, azithromycin is the preferred macrolide for treatment and postexposure prophylaxis, due to the risk of infantile hypertrophic pyloric stenosis associated with erythromycin 1.
- Hospitalization may be necessary for severe cases, particularly in infants under 6 months, to ensure close monitoring and management of complications 1.
From the FDA Drug Label
Erythromycin tablets are indicated in the treatment of infections caused by susceptible strains of the designated microorganisms in the diseases listed below: ... Pertussis (whooping cough) caused by Bordetella pertussis. Erythromycin is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious Some clinical studies suggest that erythromycin may be helpful in the prophylaxis of pertussis in exposed susceptible individuals.
Pertussis treatment with erythromycin is indicated to eliminate the organism from the nasopharynx of infected individuals. Erythromycin may also be helpful in the prophylaxis of pertussis in exposed susceptible individuals 2.
From the Research
Pertussis Treatment Overview
- Pertussis, also known as whooping cough, is a highly contagious respiratory illness caused by the bacterium Bordetella pertussis.
- The recommended treatment for pertussis is erythromycin, 40 to 50 mg/kg per day for 2 weeks 3.
- However, erythromycin has been shown to have poor tolerance due to gastrointestinal side effects, leading to the exploration of alternative antibiotics such as clarithromycin and azithromycin.
Alternative Antibiotics for Pertussis Treatment
- Clarithromycin and azithromycin have been demonstrated to be superior to erythromycin due to improved absorption and a longer half-life 3.
- A study comparing clarithromycin and azithromycin to erythromycin found that both alternative antibiotics had equivalent or superior efficacy to erythromycin in treating pertussis 3, 4, 5.
- Azithromycin has been shown to be as effective as erythromycin in treating pertussis, with fewer gastrointestinal side effects and better compliance 4.
- Clarithromycin has also been shown to be effective in treating pertussis, with a better side effect profile than erythromycin 5.
Timing of Antibiotic Administration
- Early administration of clarithromycin or azithromycin (within 7 days of cough onset) has been shown to improve clinical symptoms in infants with pertussis 6.
- A study found that infants who received antibiotics early had a shorter duration of coughing and fewer symptoms, including apnea, compared to those who received antibiotics later 6.