Pertussis medical therapy: Difference between revisions
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{{Pertussis}} | {{Pertussis}} | ||
==Overview== | ==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> | 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> | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Antimicrobial Regimens=== | ===Antimicrobial Regimens=== | ||
:* 1. '''Whooping cough''' | :* '''1.''' '''Whooping cough''' | ||
::* 1.1. '''Adults''' | ::* '''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 (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 (2): [[Erythromycin]] 2 g/day PO qid for 14 days | ||
:::* Preferred regimen (3): [[Clarithromycin]] 1 g PO bid for 7 days | :::* Preferred regimen (3): [[Clarithromycin]] 1 g PO bid for 7 days | ||
:::* Alternative regimen (intolerant of macrolides): [[Trimethoprim]] 320 | :::* 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.''' '''Infants <6 months of age''' | ||
:::* 1.2.1. '''Infants <1 month''' | :::* '''1.2.1.''' '''Infants <1 month''' | ||
::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days | ::::* 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 | ::::* Preferred regimen (2) (if azithromycin unavailable): [[Erythromycin]] 40-50 mg/kg/day PO q6h for 14 days | ||
::::* Note: | ::::* Note: [[Trimethoprim-Sulfamethoxazole]] contraindicated for infants aged < 2 months | ||
:::* 1.2.2. '''Infants of 1-5 months of age''' | :::* '''1.2.2.''' '''Infants of 1-5 months of age''' | ||
::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days | ::::* 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 (2): [[Erythromycin]] 40-50 mg/kg/day PO qid for 14 days | ||
::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days | ::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days | ||
::::* Alternative regimen | ::::* 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''' | ::* '''1.3.''' '''Infants ≥6 months of age-children''' | ||
::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg single dose {{then}} 5 mg/kg | ::::* 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 (2 g | ::::* 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 (1 g | ::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days (maximum dose 1 g/day) | ||
::::* Preferred regimen (4): [[ | ::::* Preferred regimen (4): [[Trimethoprim-Sulfamethoxazole]] 8/40 mg/kg/day PO bid for 14 days | ||
:* 2. '''Post exposure prophylaxis'''<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines | :* '''2.''' '''Post exposure prophylaxis'''<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines | ||
| url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref> | | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref> | ||
::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis | ::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis | ||
Revision as of 16:58, 14 January 2016
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 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.[1]
Medical Therapy
Antimicrobial Regimens
- 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-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
- 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.