From the Guidelines
The recommended treatment for whooping cough (pertussis) includes antibiotics, primarily macrolides such as azithromycin, clarithromycin, or erythromycin, with azithromycin being the preferred choice due to its better side-effect profile and higher compliance rates 1. When it comes to treating pertussis, the goal is to reduce symptoms, contagiousness, and the risk of complications, particularly in young infants.
- For adults and children over 6 months, azithromycin is typically given as a 5-day course (10 mg/kg on day 1, then 5 mg/kg on days 2-5) 1.
- Clarithromycin can be administered as 15 mg/kg/day in two divided doses for 7 days.
- Erythromycin is given as 40-50 mg/kg/day in four divided doses for 14 days.
- For infants under 1 month, azithromycin is preferred due to lower risk of pyloric stenosis 1.
- Trimethoprim-sulfamethoxazole is an alternative for patients who cannot tolerate macrolides. Treatment should begin as soon as possible after symptom onset, ideally within the first 1-2 weeks when it's most effective at reducing symptoms and contagiousness 1. While antibiotics help eliminate the bacteria (Bordetella pertussis) and reduce transmission, they may not significantly alter the course of illness if started late. Supportive care is also important, including:
- Adequate hydration
- Rest
- Avoiding irritants that trigger coughing Close contacts should receive antibiotic prophylaxis regardless of vaccination status, and infants with pertussis may require hospitalization for monitoring due to the risk of apnea and severe complications 1.
From the FDA Drug Label
Pertussis (whooping cough) caused by Bordetella pertussis. Erythromycin is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious Although optimal dosage and duration have not been established, doses of erythromycin utilized in reported clinical studies were 40 to 50 mg/kg/day, given in divided doses for 5 to 14 days.
The recommended treatment for whooping cough (pertussis) is erythromycin. The dosage is 40 to 50 mg/kg/day, given in divided doses for 5 to 14 days 2 2.
- The treatment is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious.
- The dosage may vary depending on the severity of the infection and the patient's age and weight.
From the Research
Diagnosis and Treatment of Whooping Cough
- The diagnosis of pertussis (whooping cough) should be confirmed using polymerase chain reaction testing, which has replaced culture as the preferred confirmatory test 3.
- Antibiotic treatment is intended to prevent transmission of pertussis to others and does not shorten the disease course or improve symptoms 3, 4.
- Azithromycin is the preferred antibiotic for treatment or prophylaxis of pertussis, and it is as effective as erythromycin estolate for the treatment of pertussis in children 3, 5.
- Other effective regimens include three days of azithromycin, seven days of clarithromycin, seven or 14 days of erythromycin estolate, and 14 days of erythromycin ethylsuccinate 4.
- Clarithromycin and azithromycin have been demonstrated to be superior to erythromycin because of improved absorption and a longer half-life, and they are better tolerated than conventional erythromycin therapy 6, 7.
Antibiotic Prophylaxis
- 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 3.
- Azithromycin is the preferred antibiotic for prophylaxis, and it can be given for 3 days 4.
Vaccination
- 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 3.
- All pregnant patients should receive Tdap between 27 and 36 weeks' gestation with each pregnancy to convey immunity to the newborn 3.