From the Guidelines
The recommended treatment for pertussis includes antibiotics, with macrolides being the first-line therapy, and azithromycin is typically prescribed for 5 days. The choice of antimicrobial agent for treatment or prophylaxis should take into account effectiveness, safety, tolerability, ease of adherence to the regimen prescribed, and cost 1. Macrolide agents such as erythromycin, clarithromycin, and azithromycin are preferred for the treatment of pertussis in persons aged >1 month, with azithromycin being the preferred macrolide for postexposure prophylaxis and treatment of infants aged <1 month 1. For patients who cannot tolerate macrolides, trimethoprim-sulfamethoxazole is an alternative 1.
Some key points to consider in the treatment of pertussis include:
- Antibiotics are most effective when started early in the illness, ideally within the first 1-2 weeks when symptoms are still mild 1.
- Supportive care is crucial and includes maintaining hydration, ensuring adequate nutrition, avoiding irritants that trigger coughing, and monitoring for complications like pneumonia or apnea, especially in infants.
- Hospitalization may be necessary for severe cases, particularly in young infants.
- Antibiotics work by eliminating the causative bacteria, Bordetella pertussis, from the respiratory tract, though the toxins produced by the bacteria may continue to cause symptoms even after the bacteria are eliminated.
It's also important to note that vaccination of susceptible persons is the most important preventive strategy against pertussis, and universal childhood pertussis vaccine recommendations have been implemented since the mid-1940s 1. However, neither vaccination nor natural disease confers complete or lifelong protective immunity against pertussis or reinfection. Other antimicrobial agents such as ampicillin, amoxicillin, tetracycline, chloramphenicol, fluoroquinolones, and cephalosporins are not recommended for treatment or postexposure prophylaxis of pertussis due to lack of clinical effectiveness or potentially harmful side effects 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 pertussis is erythromycin. The dosage is 40 to 50 mg/kg/day, given in divided doses for 5 to 14 days 2 2.
- Key points:
- Erythromycin is effective in eliminating the organism from the nasopharynx of infected individuals.
- The dosage and duration of treatment may vary depending on the severity of the infection and the patient's response to treatment.
From the Research
Recommended Treatment for Pertussis
The recommended treatment for pertussis is erythromycin, 40 to 50 mg/kg per day for 2 weeks 3. However, newer macrolides such as clarithromycin and azithromycin have been shown to be superior to erythromycin due to improved absorption and a longer half-life.
Alternative Treatment Options
- Clarithromycin: 10 mg/kg per day, twice a day for 7 days 3, 4
- Azithromycin: 10 mg/kg per day, once a day for 5 days 3, 5, 6
- Erythromycin estolate: 40 mg/kg/day in 3 divided doses for 10 days 6
- Trimethoprim/sulfamethoxazole: 7 days 7
Efficacy and Safety of Treatment Options
- Clarithromycin and azithromycin have been shown to be as effective as erythromycin in eradicating B. pertussis from the nasopharynx 3, 4, 5, 6
- Azithromycin has been shown to be better tolerated than erythromycin, with fewer gastrointestinal side effects 6
- Short-term treatment with clarithromycin or azithromycin has been shown to be equally effective as long-term treatment with erythromycin 7
Considerations for Treatment
- The choice of treatment should be based on the patient's age, weight, and medical history
- The treatment regimen should be completed as directed to ensure eradication of B. pertussis
- Patients should be monitored for side effects and compliance with the treatment regimen 6