What is the treatment for pertussis?

Treatment of Pertussis

Azithromycin is the first-line treatment for pertussis due to its once-daily dosing, excellent tolerability, and shorter treatment duration (5 days total). 1

Antibiotic Therapy

First-Line Treatment

• Azithromycin:
  • Adults: 500 mg on day 1, then 250 mg daily for 4 days (5 days total) 1
  • Children: 10 mg/kg on day 1, then 5 mg/kg daily for 4 days (5 days total) 1
  • Preferred antibiotic for both treatment and prophylaxis 2
  • In vitro data confirms activity against Bordetella pertussis 3

Alternative Antibiotics

• Erythromycin: Effective but has more gastrointestinal side effects and drug interactions 1

  • Associated with infantile hypertrophic pyloric stenosis in infants under 1 month 1

• Trimethoprim-sulfamethoxazole: Alternative option but contraindicated in:

  • Infants under 2 months
  • Pregnant women
  • Nursing mothers 1

Timing of Treatment

Early treatment is crucial:

• Most effective when initiated within the first few weeks of illness 1
• Early treatment will diminish coughing paroxysms and prevent disease spread 1
• Antimicrobial therapy should be continued for the full recommended duration to minimize treatment failure 1

Infection Control Measures

• Isolate patients 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
• Employ droplet precautions for hospitalized patients 1
• Patients should be isolated at home and away from work or school during the first 5 days of treatment 1

Important Clinical Considerations

1. Treatment Purpose: Antibiotic treatment is primarily intended to prevent transmission rather than to shorten the disease course or improve symptoms 2

2. Ineffective Treatments: The following should NOT be offered as there is no evidence of benefit:

   • Long-acting β-agonists
   • Antihistamines
   • Corticosteroids
   • Pertussis immunoglobulin 1

3. Prophylaxis: Post-exposure prophylaxis is recommended for:

   • All close contacts regardless of vaccination status
   • Most effective when initiated within 2 weeks of exposure
   • Same antimicrobial regimens as for treatment 1, 2

4. Severe Cases: In severe pertussis with hyperleukocytosis, additional interventions may be needed:

   • Plasma exchange has been reported to improve outcomes in cases with extremely elevated white blood cell counts 4
   • Ventilator support may be required in severe cases 4

Common Pitfalls

1. Delayed Treatment: Failing to start antibiotics early reduces effectiveness in preventing transmission and complications 1

2. Prophylactic Antibiotic Misuse: Using antibiotics during the late spastic period solely to prevent secondary bacterial complications is not recommended and may increase complication rates 5

3. Incomplete Treatment Course: Not completing the full antibiotic course may lead to treatment failure and continued transmission 1

4. Relying on Antibiotics Alone: Remember that vaccination remains the most effective prevention strategy 1

Short-term treatment with newer macrolides like azithromycin has been shown to be equal or superior to the standard long-term erythromycin regimen, with better compliance due to fewer side effects 6, 7.