Treatment of Whooping Cough (Pertussis)
Azithromycin is the first-line treatment for pertussis, administered as 500 mg on day 1 followed by 250 mg daily for 4 days (total 5 days) for adults, and 10 mg/kg on day 1 followed by 5 mg/kg daily for 4 days for children. 1
Antibiotic Treatment Options
First-Line Treatment
- Azithromycin: Preferred due to once-daily dosing, excellent tolerability, and shorter treatment duration 1
- Adults: 500 mg on day 1, then 250 mg daily for 4 days (5 days total)
- Children: 10 mg/kg on day 1, then 5 mg/kg daily for 4 days (5 days total)
Alternative Treatment Options
- Clarithromycin: 7-day course 1, 2
- Erythromycin: 14-day course (traditional standard) 1
- Associated with more gastrointestinal side effects including epigastric distress, abdominal cramps, nausea, vomiting, and diarrhea
- Inhibits cytochrome P450 enzyme system, leading to potentially serious drug interactions
- Associated with infantile hypertrophic pyloric stenosis in infants under 1 month
- Trimethoprim-sulfamethoxazole: 14-day course 1
- Contraindicated in infants under 2 months, pregnant women, and nursing mothers
- Higher risk of adverse effects including rash and blood dyscrasias
Timing and Effectiveness of Treatment
- Early treatment within the first few weeks is crucial to:
- Diminish coughing paroxysms
- Prevent disease spread 1
- Antibiotics effectively eliminate B. pertussis from the nasopharynx, making patients non-infectious 2, 3
- Important note: While antibiotics clear the bacteria, they do not significantly alter the subsequent clinical course of established illness 2, 3
Treatment Duration Considerations
- Short-term antibiotics (azithromycin for 3-5 days, clarithromycin for 7 days) are as effective as long-term antibiotics (erythromycin for 14 days) in eradicating B. pertussis 2, 3
- Short-term regimens have fewer side effects (RR 0.66,95% CI 0.52 to 0.83) 3
Infection Control Measures
- Patients should be isolated for 5 days from the start of antimicrobial therapy 1
- Healthcare workers should be excluded from work until 5 days after starting appropriate therapy 1
- Droplet precautions should be employed for hospitalized patients 1
Ineffective Treatments to Avoid
The following should NOT be offered to patients with pertussis as there is no evidence of benefit 1:
- Long-acting β-agonists
- Antihistamines
- Corticosteroids
- Pertussis immunoglobulin
Post-Exposure Prophylaxis
- Recommended for all close contacts regardless of vaccination status 1
- Same antimicrobial regimens as for treatment
- Most effective when initiated within 2 weeks of exposure 1
- Note: Evidence for the benefit of prophylactic treatment of pertussis contacts is insufficient 2, 3
Complications to Monitor
Complications from severe coughing can include 1:
- Pneumothorax
- Rib fracture
- Epistaxis
- Subconjunctival hemorrhage
- Subdural hematoma
- Hernia
- Rectal prolapse
- Urinary incontinence
- Loss of consciousness/cough syncope
Special Considerations
- Infants are at highest risk for severe disease and death 3, 4
- Complications are more severe in infants (apnea, pneumonia, seizures, death) 5
- In adolescents and adults, complications typically result from chronic cough 5
- Early diagnosis and treatment before the paroxysmal stage can help mitigate complications and reduce disease spread 6