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==Medical Therapy==
==Medical Therapy==
* 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, [[antibiotic]]s will not alter the course of the illness and, even without antibiotics, the patient should no longer be spreading pertussis.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
{{PBI|Bordetella pertussis}}
 
:* Bordetella pertussis<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis 2005 CDC Guidelines
* Persons with pertussis are infectious from the beginning of the catarrhal stage ([[runny nose]], [[sneezing]], [[low-grade fever]], symptoms of the [[common cold]]) through the third week after the onset of paroxysms (multiple, rapid coughs) or until 5 days after the start of effective antimicrobial treatment.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
| url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>  
 
::* 1. '''Whooping cough'''
* 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.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
:::* 1.1. '''Adults'''
 
::::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose on day 1 {{then}} 250 mg PO qd on 2-5 days
*The choice of antimicrobial should be made after consideration of the:<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
::::* Preferred regimen (2): [[Erythromycin]] 2 g/day PO qid for 14 days
** Potential for adverse events and drug interactions
::::* Preferred regimen (3): [[Clarithromycin]] 1 g PO bid for 7 days.
** Tolerability
::::* Alternative regimen (intolerant of macrolides): [[Trimethoprim]] 320 mg/day {{and}} [[Sulfamethoxazole]] 1600 mg/day PO bid for 14 days
** Ease of adherence to the regimen prescribed
:::* 1.2. '''Infants <6 months of age'''
** Cost
::::* 1.2.1. '''Infants <1 month'''
 
:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
* On March 12, 2013, the Food and Drug Administration (FDA) issued a warning that [[azithromycin]] can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm in some patients.  [[Azithromycin]] remains one of the recommended drugs for treatment and chemoprophylaxis of pertussis, but consider using an alternative drug in those who have known cardiovascular disease, including:<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
:::::* Preferred regimen (2) (if azithromycin unavailable): [[Erythromycin]] 40-50 mg/kg/day PO q6h for 14 days
** Patients with known prolongation of the [[QT interval]], a history of [[torsades de pointes]], [[long QT syndrome|congenital long QT syndrome]], [[bradyarrhythmia]]s, or uncompensated [[heart failure]]
:::::* Note: TMP-SMX contraindicated for infants aged < 2 months
** Patients on drugs known to prolong the QT interval
::::* 1.2.2. '''Infants of 1-5 months of age'''
** Patients with ongoing proarrhythmic conditions such as uncorrected [[hypokalemia]] or [[hypomagnesemia]], clinically significant [[bradycardia]], and in patients receiving Class IA ([[quinidine]], [[procainamide]]) or Class III ([[dofetilide]], [[amiodarone]], [[sotalol]]) antiarrhythmic agents.
:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
** Elderly patients and patients with cardiac disease may be more susceptible to the effects of arrhythmogenic drugs on the [[QT interval]].
:::::* 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
===Infants===
:::::* Alternative regimen: For infants aged ≥ 2 months [[TMP]] 8 mg/kg q24h {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day PO bid for 14 days
====Age ≥1 Month====
:::* 1.3. '''Infants ≥6 months of age-children'''
* [[Erythromycin]], [[clarithromycin]], and [[azithromycin]] are preferred for the treatment of pertussis in persons ≥1 month of age.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg single dose {{then}} 5 mg/kg (500 mg Maximum) qd for 2-5 days  
* For persons ≥2 months of age, an alternative to [[macrolide]]s is [[trimethoprim-sulfamethoxazole]].<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
:::::* Preferred regimen (2): [[Erythromycin]] 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days  
======Infants of 1-5 months of age======
:::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO (1 g daily Maximum) bid for 7 days
:*Preferred regimen : [[Azithromycin]] 10 mg/kg/day for 5 days {{or}} [[Clarithromycin]] 15mg/kg bid for 7 days {{or}} [[Erythromycin]] 10 mg/kg PO qid for 14 days<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
:::::* Preferred regimen (4): [[TMP]] 8 mg/kg/day {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day bid for 14 days
======Infants >6 months of age======
::* 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 : [[Azithromycin]] 10 mg/kg (500 mg max) daily for 5 days {{or}} [[Clarithromycin]] 15 mg/kg (1 g daily max)bid for 7 days {{or}} [[Erythromycin]] 10mg/kg PO (2g daily max) qid for 14 days {{or}} [[TMP-SMX]] 4 mg/40 mg/kg bid for 14 days.<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
| url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>
:*Note : [[TMP-SMX]] contraindicated in children ≤ 2months of age.
:::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
====Age <1 Month====
:::* 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
* For infants <1 month of age, [[azithromycin]] is preferred for post exposure prophylaxis and treatment because [[azithromycin]] has not been associated with [[infantile hypertrophic pyloric stenosis]] (IHPS), whereas [[erythromycin]] has.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
:::* 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.
* For infants <1 month of age, the risk of developing severe pertussis and life-threatening complications outweighs the potential risk of IHPS that has been associated with [[macrolide]] use.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
:::* 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.
* Infants <1 month of age who receive a [[macrolide]] should be monitored for the development of IHPS and for other serious adverse events.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/treatment.html Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014]</ref>
*Preferred treatment regimen include [[Azithromycin]] 10 mg/kg/day for 5 days<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>


==References==
==References==

Revision as of 18:02, 7 August 2015

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.[1]

Medical Therapy

  • Bordetella pertussis[2]
  • 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[3]
  • 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

  1. ↑ Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014
  2. ↑ "Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis 2005 CDC Guidelines".
  3. ↑ "Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines".


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