From the Guidelines
Healthcare workers exposed to pertussis should receive postexposure prophylaxis with azithromycin, clarithromycin, erythromycin, or trimethoprim-sulfamethoxazole (TMP-SMX) as soon as possible after exposure, ideally within 21 days, to prevent the development of pertussis. The choice of antibiotic depends on various factors, including the healthcare worker's medical history and potential drug interactions. According to the guidance on postexposure prophylaxis for healthcare personnel 1, azithromycin, clarithromycin, erythromycin, and TMP-SMX are recommended antimicrobial agents for postexposure prophylaxis among healthcare personnel exposed to pertussis. Some key points to consider when administering postexposure prophylaxis include:
- Initiating prophylaxis as soon as possible after exposure, ideally within 21 days
- Ensuring the healthcare worker's Tdap vaccination is current, though vaccination alone is not sufficient for post-exposure prophylaxis
- Monitoring for symptoms such as persistent cough for 21 days after exposure, even with prophylaxis
- Excluding healthcare workers with symptoms from work until completing 5 days of appropriate antibiotic therapy or until 21 days after cough onset if not treated, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1. Healthcare workers should be aware that postexposure prophylaxis is particularly important when they are in contact with persons at risk for severe disease, such as hospitalized neonates, newborn infants, and patients with chronic respiratory conditions 1.
From the Research
Prophylaxis for Pertussis Exposure in Healthcare Workers
- The use of erythromycin prophylaxis is recommended for close household contacts of patients with pertussis, as stated in the study 2.
- For healthcare workers exposed to pertussis, appropriate use of work restriction and erythromycin prophylaxis may decrease the likelihood of institutional outbreaks, according to the study 3.
- Alternative antibiotics such as clarithromycin and azithromycin may also be effective for prophylaxis, as they have been shown to be effective in treating pertussis, as stated in the studies 4 and 5.
- The study 5 found that short-term antibiotics (azithromycin for three days, clarithromycin for seven days, or erythromycin estolate for seven days) were equally effective with long-term antibiotic treatment (erythromycin estolate or erythromycin for 14 days) in the microbiological eradication of Bordetella pertussis from the nasopharynx.
- However, there is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts, as stated in the study 5.
Recommended Prophylaxis Regimens
- Erythromycin for 14 days, as recommended in the study 2.
- Clarithromycin for 7 days, as mentioned in the studies 4 and 5.
- Azithromycin for 3 days, as mentioned in the studies 4 and 5.
- Trimethoprim/sulfamethoxazole for 7 days, as mentioned in the study 5, may serve as an alternative antibiotic treatment for patients who cannot tolerate a macrolide.