From the Research
The treatment of pertussis (whooping cough) in Australia according to the Therapeutic Guidelines (ETG) primarily involves antibiotic therapy with azithromycin as the first-line treatment, as it is as effective as erythromycin but better tolerated, with fewer gastrointestinal side effects 1.
Key Considerations
- For adults and children over 6 months, azithromycin is given as 500mg on day 1, then 250mg daily for 4 days.
- For infants under 6 months, the dose is 10mg/kg on day 1, then 5mg/kg daily for 4 days.
- Alternative antibiotics include clarithromycin (7.5mg/kg up to 500mg twice daily for 7 days) or trimethoprim-sulfamethoxazole for patients who cannot tolerate macrolides.
Rationale
- Antibiotic treatment is most effective when started within 3 weeks of symptom onset and helps reduce infectivity, though it may not significantly alter the clinical course if started late 1.
- Supportive care is crucial, especially for infants and young children, including respiratory support, adequate hydration, and careful monitoring for complications such as apnea or secondary bacterial pneumonia.
- Hospitalization is often necessary for infants under 6 months, pregnant women in the third trimester, and patients with severe disease.
- Pertussis is a notifiable disease in Australia, requiring immediate reporting to public health authorities to facilitate contact tracing and prophylaxis for close contacts, particularly vulnerable individuals like unvaccinated infants.
Evidence Summary
- A study published in Pediatrics in 2004 found that azithromycin was as effective as erythromycin estolate for the treatment of pertussis in children, with fewer gastrointestinal side effects and better compliance 1.
- Another study published in The American Journal of the Medical Sciences in 2009 found that azithromycin was associated with significantly higher completion rates than erythromycin due to fewer side effects 2.