What is the treatment for pertussis (whooping cough)?

Treatment of Pertussis (Whooping Cough)

All patients with confirmed or probable pertussis should receive a macrolide antibiotic (preferably azithromycin) and be isolated for 5 days from the start of treatment, as early treatment within the first few weeks diminishes coughing paroxysms and prevents disease transmission. 1

Antibiotic Treatment

First-Line Therapy

• Macrolide antibiotics are the treatment of choice for pertussis, with azithromycin being preferred due to better tolerability and shorter treatment duration 2, 3, 4
• Treatment should be initiated immediately when pertussis is clinically suspected—do not wait for laboratory confirmation 3
• Timing is critical: Antibiotics are most effective when started within the first 2 weeks of illness (during the catarrhal or early paroxysmal phase) 1, 2

Treatment Expectations

• Antibiotics eliminate the bacteria and prevent transmission but do not alter the clinical course if started after the first few weeks of illness 1, 5, 4
• Treatment beyond 3 weeks may be offered but is unlikely to improve symptoms; however, it still prevents transmission 1, 2
• The primary goal of antibiotic therapy is to eradicate nasal bacterial carriage and reduce transmission rates 5

Alternative Antibiotics

• Trimethoprim/sulfamethoxazole is an alternative in cases of macrolide allergy or intolerance 5

Isolation Requirements

• Isolate patients for 5 days from the start of antibiotic treatment to prevent disease spread 1, 2
• Patients are most infectious during the catarrhal stage and first 3 weeks after cough onset 3

Treatments That Do NOT Work

Do not offer the following therapies, as there is no evidence they benefit patients with pertussis: 1

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

Prophylaxis for Contacts

• Antibiotic prophylaxis is recommended for household contacts of someone with pertussis 4
• Prophylaxis is also indicated for those exposed who are at high risk of severe illness (infants, immunocompromised individuals, pregnant patients in third trimester) or in close contact with high-risk individuals 4
• Azithromycin is the preferred agent for prophylaxis 4

Vaccination Recommendations

Children

• All children should receive the complete DTaP primary vaccination series (5 doses before age 7) 1, 2
• A single DTaP booster should be administered in early adolescence (ages 11-18) 1, 2

Adults

• All adults up to age 65 should receive Tdap vaccine according to CDC guidelines 1, 2
• All pregnant patients should receive Tdap between 27 and 36 weeks' gestation with each pregnancy to convey immunity to the newborn 4, 6

Critical Pitfalls to Avoid

Diagnostic Pitfalls

• Do not dismiss pertussis in vaccinated adolescents and adults—the characteristic "whoop" may be absent in previously vaccinated individuals, making diagnosis challenging 2, 3
• Pertussis immunity wanes 5-10 years after vaccination, making adolescents and adults susceptible despite childhood immunization 2
• Do not overlook pertussis in infants with atypical presentation (apneic spells, minimal cough) 3
• The catarrhal phase (first 1-2 weeks) presents with nonspecific symptoms indistinguishable from minor respiratory infections, yet this is when patients are most infectious 3

Treatment Pitfalls

• Do not delay antibiotic treatment waiting for laboratory confirmation—start treatment when clinically suspected 3
• Recognize that late treatment (after 3 weeks) will not improve symptoms but still prevents transmission 1, 2
• "Cocooning" (vaccinating close contacts) is no longer recommended because immunized patients can still contract and transmit pertussis 4