From the Guidelines
Close contacts of someone with pertussis should receive antibiotic prophylaxis, preferably with a macrolide, to prevent symptomatic infection and reduce transmission. The decision to administer postexposure chemoprophylaxis should be made after considering the infectiousness of the patient, the intensity of the exposure, and the potential consequences of severe pertussis in the contact 1.
- The recommended antimicrobial agents for postexposure prophylaxis are the same as those for treatment of pertussis, and include azithromycin, clarithromycin, or erythromycin 1.
- For infants under one month, azithromycin is preferred, while trimethoprim-sulfamethoxazole can be used for those who cannot take macrolides.
- Prophylaxis is most effective when started within 21 days of exposure to the infected person, and close contacts should also ensure their pertussis vaccinations are up-to-date 1.
- The benefits of administering an antimicrobial agent to reduce the risk for pertussis and its complications should be weighed against the potential adverse effects of the drug, especially in exposure settings that include infants aged <12 months or women in the third trimester of pregnancy 1.
- Coughing (symptomatic) household members of a pertussis patient should be treated as if they have pertussis, and administration of postexposure prophylaxis to asymptomatic household contacts can prevent symptomatic infection 1.
From the Research
Pertussis Management for Close Contacts
The management of close contacts of someone with pertussis (whooping cough) is crucial to prevent the spread of the disease.
- Post-Exposure Prophylaxis (PEP): PEP is recommended for household contacts of pertussis cases within 21 days of exposure 2.
- 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 3.
- Preferred Antibiotic: Azithromycin is the preferred antibiotic for treatment or prophylaxis 3.
- Alternative Antibiotics: Alternatives to azithromycin include clarithromycin, erythromycin, and trimethoprim-sulfamethoxazole 4, 5, 6.
- Duration of Treatment: Short-term antibiotics (azithromycin for three days, clarithromycin for seven days, or erythromycin estolate for seven days) are equally effective with long-term antibiotic treatment (erythromycin estolate or erythromycin for 14 days) in the microbiological eradication of Bordetella pertussis (B. pertussis) from the nasopharynx 5, 6.
Considerations for Close Contacts
- Vaccination: Vaccination is the mainstay of prevention, but immunized individuals can still contract and transmit pertussis 3.
- Cocooning: Cocooning (vaccinating close contacts of high-risk individuals) is no longer recommended because immunized patients can still contract and transmit pertussis 3.
- High-Risk Individuals: Individuals at high risk of severe illness, such as infants, people who are immunocompromised, or those in the third trimester of pregnancy, should receive antibiotic prophylaxis if exposed to pertussis 3, 5.