From the Guidelines
Doxycycline is not recommended for the treatment of pertussis due to lack of clinical effectiveness and potential harmful side effects in children, as stated in the 2005 CDC guidelines. The guidelines recommend macrolide agents such as erythromycin, clarithromycin, and azithromycin as the preferred treatment for pertussis in persons aged >1 month 1. For infants aged <1 month, azithromycin is preferred, while for treatment of persons aged >2 months, an alternative agent to macrolides is trimethoprim-sulfamethoxazole (TMP-SMZ) 1. Other antimicrobial agents, including tetracyclines like doxycycline, exhibit in vitro inhibitory activity against B. pertussis but have not demonstrated clinical effectiveness and may have harmful side effects in children 1.
Key points to consider when treating pertussis include:
- Starting treatment early in the course of illness, ideally within the first 1-2 weeks when symptoms first appear
- Completing the full course of antibiotics even if symptoms improve before finishing treatment
- Avoiding the use of certain antibiotics in specific patient populations, such as pregnant women, nursing mothers, or infants aged <2 months, due to potential risks
- Considering alternative antibiotics, such as TMP-SMZ, in patients who have contraindications to or cannot tolerate macrolide agents 1.
It is essential to prioritize the use of recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis, as outlined in the CDC guidelines, to ensure effective treatment and minimize potential harm to patients 1.
From the Research
Treatment of Pertussis
- The effectiveness of various antibiotics in treating pertussis has been studied, with erythromycin being the traditional choice 2, 3, 4.
- However, due to the side effects associated with erythromycin, other antibiotics such as azithromycin and clarithromycin have been found to be equally effective with fewer side effects 2, 3, 5, 4, 6.
- Azithromycin, in particular, has been shown to have higher compliance rates compared to erythromycin due to its shorter treatment course and fewer gastrointestinal side effects 2, 5.
- The use of antibiotics in pertussis treatment is primarily aimed at eliminating the bacteria from the patient, thereby reducing the risk of transmission to others, rather than altering the clinical course of the illness 4.