What is the treatment for pertussis (whooping cough) interstitial pneumonia?

From the Guidelines

The treatment for pertussis (whooping cough) interstitial pneumonia typically involves a combination of antibiotics, supportive care, and sometimes hospitalization, with azithromycin being the preferred choice due to its effectiveness and better side-effect profile compared to erythromycin, as supported by the 2005 CDC guidelines 1. The first-line treatment for pertussis interstitial pneumonia includes macrolide antibiotics, with azithromycin being the preferred option. The recommended dose for azithromycin is 10 mg/kg on day 1, followed by 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.

• Alternatives to azithromycin include clarithromycin (15 mg/kg/day divided twice daily for 7 days for children; 500 mg twice daily for 7 days for adults) or erythromycin (40-50 mg/kg/day divided four times daily for 14 days for children; 500 mg four times daily for 14 days for adults) 1.
• Supportive care is crucial and includes oxygen therapy for hypoxemia, IV fluids for dehydration, and respiratory support as needed.
• Severe cases may require hospitalization, especially in infants, young children, and those with complications.
• Early treatment is essential as antibiotics are most effective in the early catarrhal stage, helping to reduce symptoms and limit transmission, though they may have limited effect on the course of established disease, as noted in the 2005 CDC guidelines 1 and the 2006 ACCP evidence-based clinical practice guidelines 1. The pneumonia develops due to Bordetella pertussis infection damaging the respiratory epithelium and causing an inflammatory response, which antibiotics help control by eliminating the causative bacteria.
• It is also important to consider the potential risks and benefits of different antibiotics, particularly in certain age groups, such as infants under 1 month, where azithromycin is preferred due to its safety profile and lower risk of infantile hypertrophic pyloric stenosis compared to erythromycin, as recommended in the 2005 CDC guidelines 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. The treatment for pertussis (whooping cough) interstitial pneumonia is erythromycin (PO), as it is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious 2.

From the Research

Treatment for Pertussis Interstitial Pneumonia

• The treatment for pertussis (whooping cough) interstitial pneumonia typically involves the use of antibiotics to eradicate the causative bacteria, Bordetella pertussis 3, 4, 5.
• Erythromycin is a commonly recommended antibiotic for the treatment of pertussis, with a typical dosage of 40 to 50 mg/kg per day for 2 weeks 3.
• However, newer macrolides such as clarithromycin and azithromycin have been shown to be effective and better tolerated than erythromycin, with shorter treatment courses of 7 days for clarithromycin and 5 days for azithromycin 3, 4, 5.
• Azithromycin has been found to be as effective as erythromycin in treating pertussis, with fewer gastrointestinal side effects and better compliance 4.
• The use of antibiotics in the treatment of pertussis is primarily aimed at preventing the transmission of the disease to others, rather than reducing the severity or duration of symptoms in the individual patient 5.

Antibiotic Therapy in Pertussis

• The choice of antibiotic should be based on the sensitivity of the pathogen, with erythromycin, ampicillin, and augmentin being effective options 6.
• Comparative studies have shown that erythromycin is advantageous over ampicillin in terms of therapeutic activity and side effects 6.
• However, the use of antibiotics in the late stages of pertussis for the prevention of secondary bacterial complications is not recommended, as it may not be effective and may even increase the risk of complications 6.

Duration of Antibiotic Treatment

• The generally recommended duration of antibiotic treatment for pertussis is 7-10 days, but some studies suggest that this may not be sufficient in all cases, particularly in young infants 7.
• In some cases, longer treatment courses or repeated courses of antibiotics may be necessary to ensure eradication of the bacteria 7.