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Latest revision as of 17:25, 14 January 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Serge Korjian M.D.; Yazan Daaboul, M.D.

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.

Template:WH Template:WS

[CDC4-1] 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.

[pmid10609814-2] 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.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}}; {{AE}} {{ADI}}; {{Rim}}
+{{CMG}}; {{AE}} {{SSK}}; {{YD}}
 {{Pertussis}}
 ==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]].<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
+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.<ref name="CDC4">Pertussis Treatment. Centers for Disease Control and Prevention (2016). http://www.cdc.gov/pertussis/clinical/treatment.html. Accessed on January 14, 2016.</ref>
 ==Medical Therapy==
-===Bordetella pertussis===<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis 2005 CDC Guidelines
+*The mainstay of treatment of pertussis is [[antibiotic]] therapy.<ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814  }} </ref>
- | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>
-::* 1. '''Whooping cough'''
+===Timing===
-:::* 1.1. '''Adults'''
+*Early treatment of pertussis is very important.
-::::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose on day 1 {{then}} 250 mg PO qd on 2-5 days
+*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.
-::::* Preferred regimen (2): [[Erythromycin]] 2 g/day PO qid for 14 days
+*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).
-::::* Preferred regimen (3): [[Clarithromycin]] 1 g PO bid for 7 days.
+*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.
-::::* Alternative regimen (intolerant of macrolides): [[Trimethoprim]] 320 mg/day {{and}} [[Sulfamethoxazole]] 1600 mg/day PO bid for 14 days
+*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.<ref name="CDC4">Pertussis Treatment. Centers for Disease Control and Prevention (2016). http://www.cdc.gov/pertussis/clinical/treatment.html. Accessed on January 14, 2016.</ref><ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814  }} </ref>
-:::* 1.2. '''Infants <6 months of age'''
-::::* 1.2.1. '''Infants <1 month'''
+===Antimicrobial Regimens===
-:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
+:* '''1.''' '''Whooping cough'''<ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814  }} </ref>
-:::::* Preferred regimen (2) (if azithromycin unavailable): [[Erythromycin]] 40-50 mg/kg/day PO q6h for 14 days
+::* '''1.1.''' '''Adults'''
-:::::* Note: TMP-SMX contraindicated for infants aged < 2 months
+:::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose on day 1 {{then}} 250 mg PO qd on 2-5 days
-::::* 1.2.2. '''Infants of 1-5 months of age'''
+:::* Preferred regimen (2): [[Erythromycin]] 2 g/day PO qid for 14 days
-:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
+:::* Preferred regimen (3): [[Clarithromycin]] 1 g PO bid for 7 days
-:::::* Preferred regimen (2): [[Erythromycin]] 40-50 mg/kg/day PO qid for 14 days
+:::* Alternative regimen (intolerant of macrolides): [[Trimethoprim-Sulfamethoxazole]] 320/1600 mg/day PO bid for 14 days
-:::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days
+::* '''1.2.''' '''Infants <6 months of age'''
-:::::* Alternative regimen: For infants aged ≥ 2 months [[TMP]] 8 mg/kg q24h {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day PO bid for 14 days
+:::* '''1.2.1.''' '''Infants <1 month'''
-:::* 1.3. '''Infants ≥6 months of age-children'''
+::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
-:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg single dose {{then}} 5 mg/kg (500 mg Maximum) qd for 2-5 days
+::::* Preferred regimen (2) (if azithromycin unavailable): [[Erythromycin]] 40-50 mg/kg/day PO q6h for 14 days
-:::::* Preferred regimen (2): [[Erythromycin]] 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
+::::* Note: [[Trimethoprim-Sulfamethoxazole]] contraindicated for infants aged < 2 months
-:::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO (1 g daily Maximum) bid for 7 days
+:::* '''1.2.2.''' '''Infants of 1-5 months of age'''
-:::::* Preferred regimen (4): [[TMP]] 8 mg/kg/day {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day bid for 14 days
+::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
-::* 2. '''Post exposure prophylaxis'''<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines
+::::* Preferred regimen (2): [[Erythromycin]] 40-50 mg/kg/day PO qid for 14 days
- | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>
+::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days
-:::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
+::::* Alternative regimen (for infants aged ≥ 2 months): [[Trimethoprim-Sulfamethoxazole]] 8/40 mg/kg/day PO bid for 14 days
-:::* 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
+::* '''1.3.''' '''Infants ≥6 months of age-children'''
-:::* 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.
+::::* 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)
-:::* 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.
+::::* 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'''<ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814  }} </ref>
+::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
+::* Click [[Pertussis secondary prevention|here]] to learn more about postexposure prophylaxis.
 ==References==
@@ Line 43: / Line 48: @@
 [[Category:Pediatrics]]
 [[Category:Infectious diseases Project]]
-[[Category:Emergency medicine]]
 [[Category:Pulmonology]]