Prophylactic Treatment for Family Members After Confirmed Pertussis
Yes, all household and other close contacts of persons with pertussis should receive antibiotic prophylaxis for 14 days, regardless of age and vaccination status. 1
Rationale for Prophylactic Treatment
- Pertussis is highly contagious with secondary attack rates exceeding 80% among susceptible persons 2
- Prophylaxis of all household members and close contacts may prevent or minimize transmission even though data from controlled clinical trials are limited 1
- Adults and adolescents often have milder or atypical presentations of pertussis but can still transmit the infection to vulnerable populations 2, 3
- Family members can be susceptible to reinfection even 20 years after a first pertussis episode 4
Recommended Prophylactic Regimens
First-line Treatment: Macrolides
- For adults and children ≥2 weeks of age, a macrolide antibiotic is recommended as first-line prophylaxis 1:
- Erythromycin for 14 days: adults 1g/day; children 40-50 mg/kg/day 1
- Azithromycin for 5-7 days: adults 500 mg on day 1, then 250 mg daily for 4 days; children 10 mg/kg on day 1, then 5 mg/kg/day for 4 days 1, 5
- Clarithromycin for 10-14 days: adults 500 mg twice daily; children 15-20 mg/kg/day in two divided doses 1
Alternative Treatment (Macrolide Intolerance)
- For those with hypersensitivity or intolerance to macrolides (except pregnant women at term, nursing mothers, or infants <2 months):
- Trimethoprim-sulfamethoxazole for 14 days: adults 320mg/1600mg per day; children 8mg/40mg/kg/day 1
Vaccination Recommendations for Exposed Contacts
- All close contacts <7 years of age who have not completed the four-dose primary series should complete the series with minimal intervals 1
- Those who have completed a primary series but have not received a pertussis vaccine dose within 3 years of exposure should be given a booster dose 1
Important Clinical Considerations
- Prophylaxis is most effective when initiated promptly after exposure 1, 5
- Erythromycin treatment of the index case significantly reduces the attack rate in household contacts 4
- Passive immunization is not recommended for post-exposure prophylaxis 1
- Short-term antibiotic regimens (azithromycin for 3-5 days or clarithromycin for 7 days) are as effective as longer courses of erythromycin with fewer side effects 6
Special Populations
- Infants <6 months are at highest risk for severe pertussis complications including apnea, pneumonia, seizures, or death 7
- Pregnant women in the third trimester should receive prophylaxis to prevent transmission to their newborns 5
- Healthcare workers exposed to pertussis who remain asymptomatic can continue patient care while receiving chemoprophylaxis 1
By providing prophylactic antibiotics to all family members after a confirmed pertussis case, you can significantly reduce the risk of disease transmission and protect vulnerable individuals from potentially severe complications.