From the Guidelines
Post-exposure prophylaxis for whooping cough (pertussis) is recommended for close contacts of infected individuals, regardless of vaccination status, to prevent symptomatic infection and reduce the risk of complications, particularly in vulnerable individuals such as infants and pregnant women. The decision to administer postexposure chemoprophylaxis should be made after considering the infectiousness of the patient, the intensity of the exposure, and the potential consequences of severe pertussis in the contact 1.
Key Considerations
- The benefits of administering an antimicrobial agent to reduce the risk for pertussis and its complications should be weighed against the potential adverse effects of the drug 1.
- Administration of postexposure prophylaxis to asymptomatic household contacts within 21 days of onset of cough in the index patient can prevent symptomatic infection 1.
- Close contacts include household members, daycare contacts, and anyone with direct face-to-face exposure to respiratory secretions.
Recommended Antimicrobial Agents
- A macrolide can be administered as prophylaxis for close contacts of a person with pertussis if the person has no contraindication to its use 1.
- The recommended antimicrobial agents and dosing regimens for postexposure prophylaxis are the same as those for treatment of pertussis 1.
Important Notes
- Prophylaxis works by eliminating Bordetella pertussis bacteria from the respiratory tract before clinical disease develops.
- Ensuring all contacts are up-to-date with pertussis vaccination provides longer-term protection beyond the antibiotic course.
- Postexposure prophylaxis should be administered in exposure settings that include infants aged <12 months or women in the third trimester of pregnancy 1.
From the FDA Drug Label
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. Pertussis (whooping cough) caused by Bordetella pertussis.
Post-exposure prophylaxis for whooping cough may be achieved with erythromycin, as it can eliminate the organism from the nasopharynx of infected individuals and render them noninfectious.
- Key points:
- Erythromycin is effective against Bordetella pertussis.
- It can be used for prophylaxis in exposed susceptible individuals. 2
From the Research
Post Exposure Whooping Cough
- Post-exposure prophylaxis is recommended for household contacts of someone with pertussis and for those exposed to pertussis who are at high risk of severe illness, such as infants, people who are immunocompromised, or in the third trimester of pregnancy 3.
- Azithromycin is the preferred antibiotic for treatment or prophylaxis of pertussis 3.
- Antibiotic treatment is intended to prevent transmission of pertussis to others and does not shorten the disease course or improve symptoms 3, 4, 5, 6.
- Short-term antibiotics, such as azithromycin for three to five days, are as effective as long-term antibiotics, such as erythromycin for 10 to 14 days, in eradicating Bordetella pertussis from the nasopharynx 4, 5.
- Contact prophylaxis with antibiotics did not significantly improve clinical symptoms or the number of cases that developed culture-positive B. pertussis 4, 5.
- The "Identify, Isolate, Inform" tool can be used to recognize key symptoms of pertussis and risk factors for exposure, and to initiate antimicrobial therapy and post-exposure prophylaxis 7.
- Household contacts of patients with suspected pertussis or other asymptomatic, high-risk populations may benefit from post-exposure prophylactic therapy 7.