Pertussis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Serge Korjian M.D.; Yazan Daaboul, M.D.
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Overview
The mainstay of treatment of pertussis is antibiotic therapy. Early treatment is essential: individuals aged >1 year should be treated within 3 weeks of cough onset, infants aged <1 year and pregnant women (especially near term) should be treated within 6 weeks of cough onset. The recommended antimicrobial agents for treatment of pertussis are macrolides. Trimethoprim-sulfamethoxasole is an alternative in those who do not tolerate macrolide antibiotics.[1]
Medical Therapy
- The mainstay of treatment of pertussis is antibiotic therapy.[2]
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.[1][2]
Antimicrobial Regimens
- 1. Whooping cough[2]
- 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.
References
- ↑ 1.0 1.1 Pertussis Treatment. Centers for Disease Control and Prevention (2016). http://www.cdc.gov/pertussis/clinical/treatment.html. Accessed on January 14, 2016.
- ↑ 2.0 2.1 2.2 2.3 Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L; et al. (1999). "Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study". Lancet. 354 (9196): 2101–5. PMID 10609814.