From the Guidelines
Pertussis treatment primarily involves antibiotics, with macrolides being the first-line therapy, and azithromycin is recommended as the preferred treatment option due to its effectiveness, safety, and tolerability 1. The treatment of pertussis involves the use of antibiotics to eliminate the bacteria and reduce transmission. For patients older than 1 month, azithromycin is recommended at 10 mg/kg (maximum 500 mg) on day 1, followed by 5 mg/kg (maximum 250 mg) daily for days 2-5. Alternatives include clarithromycin 15 mg/kg/day divided twice daily for 7 days (maximum 1g/day) or erythromycin 40-50 mg/kg/day divided four times daily for 14 days (maximum 2g/day) 1. Some key points to consider when treating pertussis include:
- For infants younger than 1 month, azithromycin is preferred at 10 mg/kg daily for 5 days 1.
- Supportive care is crucial and includes ensuring adequate hydration, nutrition, and respiratory support.
- Cough suppressants are generally not recommended as they may interfere with clearing secretions.
- While antibiotics help eliminate the bacteria and reduce transmission, they may not significantly improve symptoms if started later in the illness when coughing paroxysms have already developed.
- Treatment should begin as soon as pertussis is suspected, without waiting for laboratory confirmation.
- Close contacts should receive prophylactic antibiotics regardless of vaccination status, and patients should be isolated until they have completed 5 days of antibiotic therapy 1. It's also important to note that maintaining high vaccination coverage rates among preschool children, adolescents, and adults and minimizing exposures of infants and persons at high risk for pertussis is the most effective way to prevent pertussis 1.
From the FDA Drug Label
Erythromycin tablets are indicated in the treatment of infections caused by susceptible strains of the designated microorganisms in the diseases listed below: ... Pertussis (whooping cough) caused by Bordetella pertussis. Erythromycin is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious Some clinical studies suggest that erythromycin may be helpful in the prophylaxis of pertussis in exposed susceptible individuals.
Treatment of Pertussis: Erythromycin is indicated for the treatment of pertussis (whooping cough) caused by Bordetella pertussis. It is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious. Additionally, erythromycin may be helpful in the prophylaxis of pertussis in exposed susceptible individuals 2.
- Key Points:
- Erythromycin is effective against Bordetella pertussis
- It eliminates the organism from the nasopharynx of infected individuals
- It may be helpful in prophylaxis of pertussis in exposed susceptible individuals
From the Research
Treatment Options for Pertussis
- The recommended treatment for pertussis is erythromycin, 40 to 50 mg/kg per day for 2 weeks 3.
- However, newer macrolides such as clarithromycin and azithromycin have been shown to be effective and better tolerated than erythromycin 3, 4, 5.
- Clarithromycin and azithromycin have improved absorption and a longer half-life compared to erythromycin, making them suitable alternatives for the treatment of pertussis 3.
- A 7-day course of clarithromycin or azithromycin has been shown to be as effective as a 14-day course of erythromycin in eradicating the bacteria and preventing relapse 3, 4, 5.
Efficacy and Safety of Antibiotics
- Studies have demonstrated that clarithromycin and azithromycin are as effective as erythromycin in treating pertussis, with eradication rates of 100% 4, 5.
- Azithromycin has been shown to be better tolerated than erythromycin, with fewer gastrointestinal side effects and higher compliance rates 5, 6.
- Erythromycin has been associated with more side effects, particularly gastrointestinal upset, which can lead to non-compliance 5, 6.
Alternative Treatment Options
- Fluoroquinolones have good in vitro activity against Bordetella pertussis and may be useful in the treatment of adult patients with pertussis, although there are no supporting clinical data at present 7.
- Trimethoprim-sulfamethoxazole is another alternative treatment option for pertussis, although its efficacy and safety have not been extensively studied 7.