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 treatment of pertussis is very important. The earlier a person, especially an infant, starts treatment the better. A reasonable guideline is to treat persons aged >1 year within 3 weeks of cough onset and infants aged <1 year and pregnant women (especially near term) within 6 weeks of cough onset. The recommended antimicrobial agents for treatment or chemoprophylaxis of pertussis are azithromycin, clarithromycin and erythromycin. Trimethoprim-sulfamethoxasole can also be used. Consider using an alternative drug to azithromycin in those who have known cardiovascular disease.

Medical Therapy

• Bordetella pertussis Return to Top

• Bordetella pertussis

• 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 320 mg/day AND Sulfamethoxazole 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: TMP-SMX 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 TMP 8 mg/kg q24h AND SMX 40 mg/kg/day PO bid for 14 days

• 1.3. Infants ≥6 months of age-children

• Preferred regimen (1): Azithromycin 10 mg/kg single dose THEN 5 mg/kg (500 mg Maximum) qd for 2-5 days
• Preferred regimen (2): Erythromycin 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
• Preferred regimen (3): Clarithromycin 15 mg/kg PO (1 g daily Maximum) bid for 7 days
• Preferred regimen (4): TMP 8 mg/kg/day AND SMX 40 mg/kg/day 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
• Note (1): Post exposure prophylaxis to an asymptomatic contacts within 21 days of onset of cough in the index patient can potentially prevent symptomatic infection
• Note (2): Close contacts include persons who have direct contact with respiratory, oral or nasal secretions from a symptomatic patient (eg: cough, sneeze, sharing food, eating utensils, mouth to mouth resuscitation, or performing a medical examination of the mouth, nose, throat.
• Note (3): Some close contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged < 1 year , persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency and cystic fibrosis.

References

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