From the Guidelines
The treatment of pertussis (whooping cough) primarily involves antibiotics, with azithromycin being the preferred choice, especially in infants under 1 month, due to its effectiveness and better side-effect profile compared to erythromycin 1. The first-line treatment for pertussis involves macrolide antibiotics, with the following dosages:
- Azithromycin: 10 mg/kg on day 1, then 5 mg/kg daily for days 2-5 for children; 500 mg on day 1, then 250 mg daily for days 2-5 for adults
- Alternatives include clarithromycin (15 mg/kg/day divided twice daily for 7 days in children; 500 mg twice daily for 7 days in adults) or 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
- Trimethoprim-sulfamethoxazole can be used for patients who cannot tolerate macrolides Antibiotics are most effective when started within the first 2-3 weeks of symptoms, helping to reduce infectiousness though they may not significantly alter the course of illness if started later 1 Supportive care is crucial and includes:
- Maintaining hydration
- Managing coughing episodes
- Ensuring adequate oxygenation
- Monitoring for complications like pneumonia or apnea, particularly in infants Hospitalization may be necessary for severe cases, especially in infants under 6 months Close contacts should receive antibiotic prophylaxis regardless of vaccination status, using the same regimens as for treatment 1 Pertussis is highly contagious, so isolation of infected individuals until they complete 5 days of antibiotic therapy is important to prevent spread 1
From the Research
Treatment Options for Pertussis
- The primary treatment for pertussis involves the use of antibiotics to prevent transmission and reduce the severity of symptoms 2, 3, 4, 5, 6.
- Macrolide antibiotics, such as azithromycin, are considered first-line treatments for pertussis, with trimethoprim/sulfamethoxazole as an alternative in cases of allergy or intolerance to macrolides 2, 5.
- A 7-day course of clarithromycin has been shown to be equally effective as a 14-day course of erythromycin in treating pertussis, with fewer adverse events and better compliance 3.
- 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, such as infants, people who are immunocompromised, or those in the third trimester of pregnancy 5, 6.
Antibiotic Therapy
- Erythromycin is a commonly used antibiotic for the treatment of pertussis, but it can have side effects that limit its usefulness in some patients 3, 6.
- Azithromycin is the preferred antibiotic for treatment or prophylaxis of pertussis due to its effectiveness and better tolerability compared to erythromycin 5.
- Clarithromycin and trimethoprim/sulfamethoxazole are alternative antibiotics that can be used to treat pertussis, especially in cases where macrolides are not suitable 2, 3, 6.