Pertussis

Antimicrobials should be administered as soon as possible during the catarrhal stage; treatment initiated after paroxysms are established may have no clinical effect. Treatment is recommended for infants who present within 6 weeks of cough onset.[29]Centers for Disease Control and Prevention. Clinical overview of pertussis. Apr 2024 [internet publication]. https://www.cdc.gov/pertussis/hcp/clinical-overview ​​

Azithromycin is the preferred treatment for infants less than ages 1 month.[10]American Academy of Pediatrics. Red book 2024-2027: report of the committee on infectious diseases. May 2024 [internet publication]. https://publications.aap.org/redbook?autologincheck=redirected [26]Public Health England. Pertussis (whooping cough): information for healthcare professionals. Dec 2018 [internet publication]. https://www.gov.uk/government/publications/pertussis-whooping-cough-factsheet-for-healthcare-professionals ​​ In the US, erythromycin is an alternative. Clarithromycin is not recommended in this age group in the US, but it is the preferred therapy in the UK, where erythromycin is also not recommended for treatment of young infants because of its association with hypertrophic pyloric stenosis. Antibiotic regimens may vary in different locations. Regimens given here are based on US guidance; you should consult your local guidance.

Infants ages under 1 month who receive a macrolide should be monitored for hypertrophic pyloric stenosis.

Treatment prior to test results should be considered if the clinical history is suggestive of pertussis because of the highly transmissible nature of the infection and potential delays in obtaining diagnostic test results.

Doses and regimens used for postexposure prophylaxis are the same as those for treatment.

Antimicrobials should be administered as soon as possible during the catarrhal stage; treatment initiated after paroxysms are established may have no clinical effect. Treatment is recommended for patients within 3 weeks of cough onset, and within 6 weeks for pregnant women, immunocompromised people, or people otherwise at high risk of severe pertussis.[29]Centers for Disease Control and Prevention. Clinical overview of pertussis. Apr 2024 [internet publication]. https://www.cdc.gov/pertussis/hcp/clinical-overview Treatment prior to test results should be considered if the clinical history is suggestive of pertussis or the patient is at high risk of severe pertussis, because of the highly transmissible nature of the infection and potential delays in obtaining diagnostic test results.

First-line treatment for suspected or confirmed cases is a macrolide antibiotic (azithromycin, clarithromycin, erythromycin).[10]American Academy of Pediatrics. Red book 2024-2027: report of the committee on infectious diseases. May 2024 [internet publication]. https://publications.aap.org/redbook?autologincheck=redirected [26]Public Health England. Pertussis (whooping cough): information for healthcare professionals. Dec 2018 [internet publication]. https://www.gov.uk/government/publications/pertussis-whooping-cough-factsheet-for-healthcare-professionals [29]Centers for Disease Control and Prevention. Clinical overview of pertussis. Apr 2024 [internet publication]. https://www.cdc.gov/pertussis/hcp/clinical-overview ​ Azithromycin and clarithromycin are generally preferred because of fewer adverse drug effects and more convenient dosing regimens. Antibiotic regimens may vary in different locations. Regimens given here are based on US guidance; you should consult your local guidance. Clarithromycin should not be used in pregnant women unless the benefits outweigh the risks and no alternative therapy is available.

In the UK, erythromycin is preferred for the treatment of pregnant women; clarithromycin and azithromycin are not recommended.[26]Public Health England. Pertussis (whooping cough): information for healthcare professionals. Dec 2018 [internet publication]. https://www.gov.uk/government/publications/pertussis-whooping-cough-factsheet-for-healthcare-professionals

Trimethoprim/sulfamethoxazole is indicated in people for whom macrolides are contraindicated or not tolerated and in cases of suspected or confirmed macrolide resistance.[10]American Academy of Pediatrics. Red book 2024-2027: report of the committee on infectious diseases. May 2024 [internet publication]. https://publications.aap.org/redbook?autologincheck=redirected [26]Public Health England. Pertussis (whooping cough): information for healthcare professionals. Dec 2018 [internet publication]. https://www.gov.uk/government/publications/pertussis-whooping-cough-factsheet-for-healthcare-professionals ​ An increased risk of congenital malformations following maternal use of trimethoprim/sulfamethoxazole during pregnancy has been observed. It should be used during pregnancy only if the benefits outweigh the risks to the fetus, especially during the first trimester.

Doses and regimens used for postexposure prophylaxis are the same as those for treatment.