From the Guidelines
Pertussis treatment primarily involves antibiotics, with macrolides being the first-line therapy, and azithromycin is recommended as the preferred choice for patients of all ages, including infants younger than 1 month, due to its effectiveness and better side-effect profile compared to erythromycin and clarithromycin 1. The treatment regimens for pertussis are as follows:
- For patients older than 1 month, azithromycin is recommended at 10 mg/kg (maximum 500 mg) on day 1, followed by 5 mg/kg (maximum 250 mg) daily for days 2-5.
- Alternatives include clarithromycin 15 mg/kg/day divided twice daily for 7 days (maximum 1 g/day) or erythromycin 40-50 mg/kg/day divided four times daily for 14 days (maximum 2 g/day).
- For infants younger than 1 month, azithromycin is the preferred choice at 10 mg/kg daily for 5 days, with close monitoring for infantile hypertrophic pyloric stenosis (IHPS) and other serious adverse events 1. Some key points to consider in the treatment of pertussis include:
- Treatment should begin as soon as pertussis is suspected, ideally within the first 1-2 weeks of symptoms, to reduce transmission and prevent complications 1.
- Supportive care, including maintaining hydration, managing coughing episodes, and monitoring for complications, is also important in the management of pertussis.
- Close contacts should receive antibiotic prophylaxis with the same regimens to prevent spread of the disease.
- Antibiotics work by eliminating Bordetella pertussis bacteria from the respiratory tract, reducing infectiousness, although the characteristic cough may persist for weeks due to airway damage and inflammation already caused by bacterial toxins 1.
From the Research
Treatment Options for Pertussis
The treatment for Pertussis (Whooping Cough) includes:
- Antimicrobial chemotherapy to reduce the level of bacterial colonization of the respiratory tract 2
- Supportive treatment, such as nasopharyngeal suction, oxygen, and parenteral fluids, especially for infants under 1 year old who are at greatest risk of complications and permanent sequelae 2
- Steroids and beta2-agonists may be used in the management of severe neonatal pertussis 2
Antibiotic Treatment
- Erythromycin is accepted as the treatment of choice for pertussis, reducing the severity and duration of the disease, even when started during the paroxysmal phase 2, 3
- A 14-day course of erythromycin is recommended, although a 7-day course may have similar efficacy in terms of eradication and prevention of relapse 2
- Alternatives to erythromycin include:
- Clarithromycin, which has been shown to be equally effective as erythromycin in treating pertussis, with a better side effect profile 4, 5
- Azithromycin, which is a first-line treatment to prevent transmission and has been shown to be effective in treating pertussis 6, 4
- Trimethoprim-sulfamethoxazole, which is an alternative in cases of allergy or intolerance to macrolides 6
Prevention and Vaccination
- Immunization against pertussis is essential for disease prevention, with current recommendations including the administration of five doses of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine to children before seven years of age, and a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) booster between 11 and 18 years of age 6
- Recent efforts have focused on the vaccination of adolescents and adults, with new recommendations for a single dose of the Tdap booster if it has not been previously administered 6, 3