Pertussis Treatment and Prophylaxis
Updated 12/05
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Antimicrobials are recommended for both treatment of pertussis cases
and prophylaxis of case contacts. The same regimen is used for both.
- Cases should be treated as early in the course of illness as possible.
Because pertussis is toxin-mediated, symptoms do not necessarily resolve
with treatment. If treatment is started early in the course of illness
(during the catarrhal stage), symptoms may be lessened. Cases will become
noninfectious after completing five days of antibiotic treatment. Treatment
initiated more than three weeks after onset of illness is of no value
because viable organisms are no longer present.
- Close contacts of pertussis cases may be treated with antimicrobials
to prevent infection. Prophylaxis should be initiated as soon as possible
within 21 days (the maximum incubation period for pertussis) of exposure
to an infectious case.
NOTE REVISED RECOMMENDATIONS: All three macrolides
are now considered equally appropriate as first line agents for the treatment
or prophylaxis of pertussis for persons 6 months of age and older. See
specifics for infants < 6 months.
Table 1. Antibiotic Treatment and Prophylaxis
| DRUG |
INFANT (< 6 months of age) |
CHILD (> 6 months of age) |
ADULT |
| Azithromycin [1,4]
(3-day course not yet approved for treatment of pertussis)
|
1-5 months:10 mg/kg/day orally daily
for 5 days
<1 month of age: same as above and
is the preferred choice for infants <1
month old |
10 mg/kg/day orally on the first day (maximum 500 mg), 5 mg/kg
once daily on days 2-5 (maximum 250 mg/day) |
500 mg orally on the first day, 250 mg once daily on days 2-5
|
| Clarithromycin [2,4]
Not recommended for use in pregnant women |
not recommended for use in infants < 6 months of age; see
child dose for infants > 6 months of age |
15 mg/kg/day orally divided into 2 doses/day for 7 days (maximum
1 g/day) |
500 mg twice daily for 7 days |
| Erythromycin [1,3,4]
|
Estolate preparation preferred if available
1-5 months: 40-50 mg/kg/day orally divided
into 4 doses/day for 14 days (maximum 2 g/day)
<1 month of age: same as above, but
should only be used as an alternate drug.
Drug use is associated with elevated risk of IHPS |
40-50 mg/kg/day orally divided into 4 doses/day for 14 days (maximum
2 g/day) |
2 g/day orally divided into 4 doses/day for 14 days |
| Trimethoprim-
Sulfamethoxazole [2,4]
For those not able to tolerate macrolides.Not recommended for use
in pregnant or nursing women |
not recommended for use in children < 2 months of age; see child
dose for infants > 2 months of age |
8 mg TMP/40 mg SMX/kg/day orally divided into 2 doses/day for 14
days (maximum 320mg TMP/1600mg SMX/ day) |
320 mg TMP/1600 mg SMX per day orally divided into 2 doses/day
for 14 days |
1. FDA Pregnancy Category B drug
2. FDA Pregnancy Category C drug.
3. Some authorities prefer the
estolate preparation for children but recommend avoiding its use in adults
and pregnant women
4. Source: Centers For Disease and
Control (CDC): Recommendations for Pertussis Treatment and Prophylaxis –
January 2005. Posted on CDC’s website July 2005 at http://www.cdc.gov/nip/publications/pertussis/guide.htm
|
