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. The preferred dosing for azithromycin is 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 azithromycin include clarithromycin and erythromycin, with dosing as follows: clarithromycin (15 mg/kg/day divided twice daily for 7 days in children; 500 mg twice daily for 7 days in adults) and erythromycin (40-50 mg/kg/day divided four times daily for 14 days in children; 500 mg four times daily for 14 days in adults) 1. For patients who cannot tolerate macrolides, trimethoprim-sulfamethoxazole is an option.
Antibiotics are most effective when started within the first 2-3 weeks of symptoms and help reduce transmission, though they may not significantly alter the course of illness if started later. Supportive care includes:
- Maintaining hydration
- Managing coughing episodes
- Ensuring adequate nutrition
- Monitoring for complications like pneumonia or apnea, particularly in infants. Hospitalization may be necessary for severe cases, especially in infants under 6 months. Household contacts should receive prophylactic antibiotics regardless of vaccination status, and vaccination remains the best prevention strategy for this bacterial respiratory infection caused by Bordetella pertussis 1.
From the Research
Treatment Options for Pertussis
- The primary treatment for pertussis involves the use of antibiotics to eradicate nasal bacterial carriage and reduce transmission rates 2, 3, 4, 5, 6.
- Macrolide antibiotics, such as azithromycin, are considered first-line treatments for pertussis, with alternatives including trimethoprim/sulfamethoxazole for patients with allergies or intolerance to macrolides 2, 5, 6.
- Erythromycin is also an accepted treatment option, although it may have more side effects and lower compliance compared to newer macrolides like clarithromycin and azithromycin 3, 4, 5, 6.
- Short-term antibiotic regimens, such as 3-day azithromycin or 7-day clarithromycin, have been shown to be equally effective as long-term regimens (14-day erythromycin) in microbiological eradication and clinical improvement 4, 5.
Antibiotic Regimens
- Effective antibiotic regimens for pertussis include:
- 3 days of azithromycin
- 7 days of clarithromycin
- 7 or 14 days of erythromycin estolate
- 14 days of erythromycin ethylsuccinate
- 7 days of trimethoprim/sulfamethoxazole (as an alternative for patients who cannot tolerate macrolides) 5
- These regimens can help eliminate B. pertussis from patients, reducing the risk of transmission to others 2, 3, 5, 6.