From the Guidelines
For a non-symptomatic patient exposed to whooping cough (pertussis), the recommended approach is post-exposure prophylaxis with antibiotics, specifically a macrolide, to prevent disease development and reduce transmission risk. The decision to administer postexposure chemoprophylaxis should be made after considering the infectiousness of the patient and the intensity of the exposure, the potential consequences of severe pertussis in the contact, and possibilities for secondary exposure of persons at high risk from the contact 1.
Key Considerations
- The preferred medication is azithromycin, given as 500mg on day 1, followed by 250mg daily for days 2-5, as it has been shown to be effective in preventing symptomatic infection when administered within 21 days of onset of cough in the index patient 1.
- Alternatives include clarithromycin (500mg twice daily for 7 days) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily for 14 days), although azithromycin is generally preferred due to its better side-effect profile and compliance 1.
- Treatment should begin as soon as possible after exposure, and the patient should monitor for symptoms like persistent cough for 21 days after exposure.
- Close contacts, especially household members, pregnant women, and those with contact with infants or immunocompromised individuals, should also receive prophylaxis to prevent secondary transmission 1.
- Vaccination status should be reviewed, and if not up-to-date, a Tdap booster is recommended, although this will not prevent the current exposure risk 1.
From the Research
Recommendations for Non-Symptomatic Patients After Exposure to Whooping Cough
- The use of antibiotics for post-exposure prophylaxis (PEP) in non-symptomatic patients after exposure to whooping cough is recommended, especially for household contacts and those at high risk of severe illness 2, 3, 4.
- Azithromycin is the preferred antibiotic for treatment or prophylaxis, with a recommended course of 3 days 2, 4.
- Other effective regimens include 7 days of clarithromycin, 7 or 14 days of erythromycin estolate, and 14 days of erythromycin ethylsuccinate 2.
- The value of contact prophylaxis is uncertain, and there is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts 2.
- Daily symptom monitoring without PEP may be considered non-inferior to PEP after pertussis exposure in Tdap-vaccinated healthcare personnel, but further study is needed to confirm this approach 5.
High-Risk Groups
- Household contacts of patients with suspected pertussis, especially infants, pregnant women in their third trimester, and childcare workers, may benefit from post-exposure prophylactic therapy 6, 4.
- Individuals who are immunocompromised or in close contact with someone at high risk of severe illness may also require antibiotic prophylaxis 4.