Pertussis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]; Rim Halaby, M.D. [3]

Pertussis Microchapters
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Overview

Early management of pertussis is very important. A reasonable guideline is to treat individuals aged >1 year within 3 weeks of cough onset and infants ages <1 year and pregnant women (especially near term) within 6 weeks of cough onset. The preferred antimicrobial agent for treatment of pertussis is either Azithromycin, Clarithromycin or Erythromycin. Trimethoprim-sulfamethoxasole can be used in those patients who are unable to tolerate macrolide antibiotics. An alternative drug to Azithromycin may be administered to those who have known cardiovascular disease.

Medical Therapy

• The mainstay of treatment of pertussis is antibiotic therapy.

Timing

• Early treatment of pertussis is very important.
• The earlier a person, especially an infant, starts treatment the better. If treatment for pertussis is started early in the course of illness, during the first 1 to 2 weeks before coughing paroxysms occur, symptoms may be lessened.
• Clinicians should strongly consider treating prior to test results if clinical history is strongly suggestive or patient is at risk for severe or complicated disease (e.g., infants).
• If the patient is diagnosed late, antibiotics will not alter the course of the illness and, even without antibiotics, the patient should no longer be spreading pertussis.
• It is recommended to treat persons older than 1 year of age within 3 weeks of cough onset and infants younger than 1 year of age and pregnant women (especially near term) within 6 weeks of cough onset.

Antimicrobial Regimens

• 1. Whooping cough

• 1.1. Adults

• Preferred regimen (1): Azithromycin 500 mg PO single dose on day 1 THEN 250 mg PO qd on 2-5 days
• Preferred regimen (2): Erythromycin 2 g/day PO qid for 14 days
• Preferred regimen (3): Clarithromycin 1 g PO bid for 7 days
• Alternative regimen (intolerant of macrolides): Trimethoprim-Sulfamethoxazole 320/1600 mg/day PO bid for 14 days

• 1.2. Infants <6 months of age

• 1.2.1. Infants <1 month

• Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
• Preferred regimen (2) (if azithromycin unavailable): Erythromycin 40-50 mg/kg/day PO q6h for 14 days
• Note: Trimethoprim-Sulfamethoxazole contraindicated for infants aged < 2 months

• 1.2.2. Infants of 1-5 months of age

• Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
• Preferred regimen (2): Erythromycin 40-50 mg/kg/day PO qid for 14 days
• Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days
• Alternative regimen (for infants aged ≥ 2 months): Trimethoprim-Sulfamethoxazole 8/40 mg/kg/day PO bid for 14 days

• 1.3. Infants ≥6 months of age-children

• Preferred regimen (1): Azithromycin 10 mg/kg PO single dose THEN 5 mg/kg PO qd for 2-5 days (maximum dose 500 mg/day)
• Preferred regimen (2): Erythromycin 40-50 mg/kg PO qid for 14 days (maximum dose 2 g/day)
• Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days (maximum dose 1 g/day)
• Preferred regimen (4): Trimethoprim-Sulfamethoxazole 8/40 mg/kg/day PO bid for 14 days

• 2. Post exposure prophylaxis

• Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
• Click here to learn more about postexposure prophylaxis.

References

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