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.

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]

• The mainstay of treatment of pertussis is antibiotic therapy.^[2]

• 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]

• 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.

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