From the Guidelines
Amoxicillin is not effective for treating pertussis (whooping cough). The recommended antibiotics for pertussis are macrolides, with azithromycin being the first-line treatment, as it has been shown to be effective in treating pertussis and has a better side-effect profile compared to other antibiotics 1. For adults and children, azithromycin is typically prescribed as a 5-day course (10 mg/kg on day 1, maximum 500 mg, followed by 5 mg/kg on days 2-5, maximum 250 mg daily).
Alternatives to Azithromycin
Alternatives to azithromycin include:
- Clarithromycin (15 mg/kg/day in two divided doses for 7 days, maximum 1 g/day)
- Erythromycin (40-50 mg/kg/day in four divided doses for 14 days, maximum 2 g/day) For patients who cannot tolerate macrolides, trimethoprim-sulfamethoxazole is an option.
Key Considerations
Key considerations when treating pertussis include:
- Antibiotics are most effective when started within the first 3 weeks of symptom onset and can reduce transmission even if symptoms have been present longer
- Pertussis is caused by the bacterium Bordetella pertussis, which is not susceptible to amoxicillin because this antibiotic does not achieve adequate concentrations in the respiratory secretions where the bacteria reside, and it doesn't effectively target the pathogen's mechanism of infection, as noted in the 2005 CDC guidelines 1.
Additional Evidence
Additional evidence from a large multicenter randomized trial supports the use of azithromycin for the treatment of pertussis in children, with a better side-effect profile and improved compliance compared to erythromycin 1. The use of erythromycin and trimethoprim-sulfamethoxazole for the treatment of pertussis has also been recommended by the Immunization Practices Advisory Committee (ACIP) 1.
From the Research
Treatment of Pertussis
- The primary goal of antibiotic treatment for pertussis is to prevent transmission to others, rather than to shorten the disease course or improve symptoms 2.
- Antibiotics such as erythromycin, clarithromycin, and azithromycin have been shown to reduce the level of bacterial colonization of the respiratory tract and prevent transmission 3, 4, 5.
- Azithromycin is currently the preferred antibiotic for treatment or prophylaxis of pertussis 2.
Effectiveness of Amoxicillin
- There is no evidence to suggest that amoxicillin is effective in treating pertussis.
- The studies reviewed do not mention amoxicillin as a treatment option for pertussis, instead focusing on macrolide antibiotics such as erythromycin, clarithromycin, and azithromycin 6, 3, 4, 2, 5.
Alternative Treatment Options
- Macrolide antibiotics such as azithromycin and clarithromycin are considered first-line treatments for pertussis due to their effectiveness in preventing transmission and reducing disease severity 3, 4, 2, 5.
- Trimethoprim/sulfamethoxazole is an alternative treatment option in cases of allergy or intolerance to macrolides 6.