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]
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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.[1]
Medical Therapy
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[2]
- 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.