What is the treatment and management approach for pertussis (whooping cough)?

From the Guidelines

The treatment of pertussis (whooping cough) involves antibiotics, supportive care, and preventive measures, with macrolide antibiotics being the first-line treatment, and azithromycin being the preferred choice, as it has been shown to be effective in reducing the duration and severity of symptoms and lessening the period of communicability 1. The most recent and highest quality study, published in 2006, recommends that children and adult patients with confirmed or probable whooping cough should receive a macrolide antibiotic and should be isolated for 5 days from the start of treatment because early treatment within the first few weeks will diminish the coughing paroxysms and prevent spread of the disease 1. Some key points to consider in the treatment and management of pertussis include:

• Macrolide antibiotics, such as azithromycin, are the first-line treatment for pertussis, with a recommended dose of 10 mg/kg on day 1, then 5 mg/kg daily for days 2-5 for children, and 500 mg on day 1, then 250 mg daily for days 2-5 for adults 1.
• Alternatives to macrolides include clarithromycin and erythromycin, with trimethoprim-sulfamethoxazole being an option for patients who cannot tolerate macrolides 1.
• Supportive care is crucial and includes maintaining hydration, providing small frequent meals, ensuring adequate rest, avoiding irritants that trigger coughing, and suctioning secretions in infants 1.
• Prevention through vaccination remains the most effective strategy, with close contacts of confirmed cases often receiving prophylactic antibiotics regardless of vaccination status to prevent spread 1. It is also important to note that long-acting β-agonists, antihistamines, corticosteroids, and pertussis Ig should not be offered to patients with whooping cough, as there is no evidence that they benefit these patients 1. Overall, the goal of treatment and management of pertussis is to reduce the severity and duration of symptoms, prevent spread of the disease, and prevent complications, particularly in high-risk populations such as infants and young children.

From the Research

Treatment and Management Approach for Pertussis

The treatment and management approach for pertussis (whooping cough) involves a combination of antibiotic therapy and vaccination.

• Antibiotic treatment is intended to prevent transmission of pertussis to others and does not shorten the disease course or improve symptoms 2.
• Azithromycin is the preferred antibiotic for treatment or prophylaxis 2, 3.
• Antibiotic prophylaxis is recommended for household contacts of someone with pertussis and for those exposed to pertussis who are at high risk of severe illness (e.g., infants, people who are immunocompromised or in the third trimester of pregnancy) or in close contact with someone at high risk 2.

Vaccination Recommendations

• Patients 11 years or older should receive at least one dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, although Tdap may replace any dose of the tetanus and diphtheria toxoids (Td) vaccine 2.
• All pregnant patients should receive Tdap between 27 and 36 weeks' gestation with each pregnancy to convey immunity to the newborn 2.
• The Advisory Committee on Immunization Practices recommends administering diphtheria, tetanus and acellular pertussis (DTaP) vaccines to children at 2,4,6,15-18 months, and 4-6 years of age; preferably with the same-brand vaccine for the whole series 4.

Duration of Immunity

• The duration of immunity conferred by DTaP vaccines remains incompletely quantified, but it is widely believed to be responsible for the growing burden of pertussis in the United States 5.
• A study found that more than 65% of children remained immune to pertussis 5 years after the last DTaP dose, suggesting that DTaP vaccines confer imperfect, but long-lived protection 5.