Antibiotic regimens for pertussis
The evidence that antibiotic therapy alters the clinical course of pertussis is unclear. However, antibiotic therapy effectively eliminates Bordetella pertussis from the nasopharynx and minimises transmission to susceptible contactsAltunaiji, 2007. Antibiotic therapy is recommended if pertussis is diagnosed within 3 weeks of cough or other symptom onset. Advise patients to avoid contact with others (especially young children) until antibiotic therapy has been taken for at least 5 days. After 3 weeks of cough or other symptom onset, patients are rarely infectious and antibiotic therapy is not indicated.
Children 12 months or younger have the highest risk of morbidity and mortality from pertussis, and may require hospitalisation for supportive care of complications, such as apnoea, hypoxaemia and feeding difficulties. For children with pertussis, useBace, 1999CDC, 2005Communicable Diseases Network Australia (CDNA), 2024Langley, 2004Pichichero, 2003:
term neonate and child younger than 6 months: 10 mg/kg orally, daily for 5 days
child 6 months or older: 10 mg/kg up to 500 mg orally, on day 1, then 5 mg/kg up to 250 mg daily for a further 4 days. Total duration of therapy is 5 days
OR
2clarithromycin (child 1 month or older) 7.5 mg/kg up to 500 mg orally, 12-hourly for 7 days clarithromycin
OR
2trimethoprim+sulfamethoxazole (child 1 month or older) 4+20 mg/kg up to 160+800 mg orally, 12-hourly for 7 days. trimethoprim + sulfamethoxazole
Administration of the oral formulation of clarithromycin to children may be difficult because the product is often unpalatableElgammal, 2023Matsui, 1997; consider using azithromycin if possible.
For adults with pertussis, useAltunaiji, 2007CDC, 2005Pichichero, 2003Communicable Diseases Network Australia (CDNA), 2024:
1azithromycin 500 mg orally, on day 1, then 250 mg orally, daily for a further 4 days. Total duration of therapy is 5 days azithromycin azithromycin azithromycin
OR
1clarithromycin 500 mg orally, 12-hourly for 7 days clarithromycin clarithromycin clarithromycin
OR
2trimethoprim+sulfamethoxazole 160+800 mg orally, 12-hourly for 7 days. trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole
Azithromycin and clarithromycin are the preferred macrolides for the treatment of pertussis; there is no evidence to support the use of roxithromycin and although erythromycin is active against B. pertussis, it is poorly tolerated and requires more frequent dosingLangley, 2004.