What is the recommended treatment for pertussis?

Treatment for Pertussis

Azithromycin is recommended as the first-line treatment for pertussis due to its once-daily dosing, excellent tolerability, and shorter treatment duration compared to other antibiotics. 1

Recommended Antibiotic Regimens

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, 2

Alternative Options:

1. Erythromycin

   • Adults: 500 mg four times daily or 500 mg every 12 hours for 14 days 1, 3
   • Children: 40-50 mg/kg/day in divided doses for 14 days 3
   • Note: Associated with more gastrointestinal side effects (nausea, vomiting, diarrhea) and poorer compliance compared to azithromycin 2, 4

2. Trimethoprim-sulfamethoxazole

   • Contraindications: Infants under 2 months, pregnant women, and nursing mothers 1

Timing and Effectiveness of Treatment

• Early treatment (within the first few weeks of illness) is crucial to:

  • Diminish coughing paroxysms
  • Prevent disease spread 1

• Antimicrobial therapy should be continued for the full recommended duration to minimize treatment failure 1

• Important caveat: While antibiotics can eliminate the organism from the nasopharynx (making patients non-infectious), they may not significantly alter the course of established symptoms if started during the paroxysmal or convalescent phases 5

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
• Use droplet precautions for hospitalized patients 1

What NOT to Offer

The following treatments should not be offered to patients with pertussis as there is no evidence of benefit 1:

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

Comparative Effectiveness of Antibiotics

Clinical studies have demonstrated that azithromycin is as effective as erythromycin for bacterial eradication (100% efficacy for both) but with significantly fewer side effects 2:

• Gastrointestinal adverse events: 18.8% with azithromycin vs. 41.2% with erythromycin
• Compliance rates: 90% with azithromycin vs. 55% with erythromycin 2, 4

Post-exposure Prophylaxis

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

Special Considerations

• Monitor for potential complications from severe coughing, including pneumothorax, rib fracture, epistaxis, subconjunctival hemorrhage, subdural hematoma, hernia, rectal prolapse, urinary incontinence, and loss of consciousness/cough syncope 1

• For pregnant women with pertussis, azithromycin is preferred due to better tolerability and safety profile compared to erythromycin, which has more drug interactions and gastrointestinal side effects 1, 5