From the Guidelines
Elevated pertussis IgG and IgA antibodies alone do not necessarily warrant antibiotic treatment, and antibiotics should be prescribed based on clinical symptoms and PCR or culture confirmation of active Bordetella pertussis infection, not solely on serological markers. The decision to treat with antibiotics should be based on a clinical diagnosis rather than waiting for laboratory confirmation, as treatment is most effective when started within the first 1-2 weeks of symptom onset, primarily to reduce transmission rather than modify the disease course in the already infected individual 1.
Some key points to consider in the treatment of pertussis include:
- The recommended treatment is azithromycin, clarithromycin, or trimethoprim-sulfamethoxazole, with the specific dosage and duration depending on the patient's age and other factors 1
- Elevated IgG and IgA antibodies often indicate past infection or vaccination rather than current infection requiring treatment, as these antibodies typically appear later in the disease course or persist after infection resolution
- The benefits of adding long-acting β-agonists, antihistamines, corticosteroids, and pertussis Ig have been studied in pertussis infection, but no significant benefit has been found with any of these interventions in controlling the paroxysms of coughing 1
In terms of specific treatment recommendations, azithromycin is a preferred treatment option, with a dosage of 10 mg/kg on day 1, then 5 mg/kg days 2-5 for children, and 500 mg on day 1, then 250 mg days 2-5 for adults. Clarithromycin and trimethoprim-sulfamethoxazole are also effective alternatives, with specific dosages and durations outlined in the guidelines 1.
It's also important to note that prevention of pertussis through vaccination is a critical aspect of reducing the incidence of the disease, and acellular pertussis vaccines have been shown to be highly effective in preventing pertussis in all age groups 1.
From the Research
Elevated Pertussis Immunoglobulin G (IgG) and Immunoglobulin A (IgA)
- Elevated levels of Pertussis IgG and IgA indicate a past infection or immunization against Pertussis [(2,3,4,5,6)].
Treatment with Antibiotics
- Antibiotics are effective in eliminating Bordetella pertussis from patients with the disease, rendering them non-infectious [(2,3,4,5,6)].
- Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) are as effective as long-term (erythromycin for 10 to 14 days) in eradicating B. pertussis from the nasopharynx [(5,6)].
- However, antibiotics do not alter the subsequent clinical course of the illness [(5,6)].
Specific Antibiotic Regimens
- Effective regimens include: three days of azithromycin, seven days of clarithromycin, seven or 14 days of erythromycin estolate, and 14 days of erythromycin ethylsuccinate 5.
- Considering microbiological clearance and side effects, three days of azithromycin or seven days of clarithromycin are the best regimens 5.
- Seven days of trimethoprim/sulfamethoxazole also appeared to be effective for the eradication of B. pertussis from the nasopharynx and may serve as an alternative antibiotic treatment for patients who cannot tolerate a macrolide 5.