Antibiotic prophylaxis of pertussis

Altunaiji S, et al. Antibiotics for whooping cough (pertussis). Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004404. (Edited (no change to conclusions), comment added to review in Issue 3, 2013.)

“This systematic review of RCTs examining the treatment of whooping cough has found that antibiotic treatment is effective in eliminating B. pertussis from the nasopharynx and thus rendering participants non-infectious, but does not alter the clinical course of the illness. Prophylaxis with antibiotic was significantly associated with side effects; it did not significantly improve clinical symptoms, prevent the development of culture-positive B. pertussis, nor paroxysmal cough for more than two weeks, in contacts older than six months of age.”

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Chapter 129: Pertussis and Other Bordetella Infections in Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed. (2014), pgs.1616-1639.e12.

Pertussis: Isolation and Prophylactic Measures

“Erythromycin, azithromycin, or clarithromycin treatment in the index case shortens the duration of communicability of the organisms and thus limits spread of the disease. During the first few days of treatment, contact with susceptible persons should be avoided. In general, close contacts (household members, those in daycare centers, playmates) of the index case should be protected from infection. Such protection can be implemented by the prophylactic use of erythromycin for 14 days, azithromycin for 5 days, or clarithromycin for 7 days. [7 67 333 465] Active immunization of all exposed persons (children, adolescents, and adults) who are not adequately vaccinated also should be conducted.

The use of prophylactic antibiotics in adolescents and adults in exposure situations such as classrooms and hospital settings frequently is recommended. This approach often involves many people and considerable expense.

In our experience, the side effects of erythromycin and other macrolides are such that adult compliance is poor. Therefore, our opinion is that erythromycin and other macrolides should generally not be used prophylactically in these large group settings but only for treatment at the first sign of respiratory illness in those exposed.”

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Laurens MB. Common indications for pediatric antibiotic prophylaxis. Emerg Med Clin North Am. 2013 Aug;31(3):875-94.

First-Line Treatments for Pertussis

“Treatment of those exposed to cases of pertussis includes a 2-pronged approach of vaccination and chemoprophylaxis.

Pertussis exposures should be evaluated for pertussis immunization status. Those not immunized or underimmunized should be vaccinated according to the recommended schedule at www.cdc.gov/vaccines . Completion of the primary 5-vaccination series for infants and children younger than 7 years should be documented. The fifth dose is not required if the fourth dose was given on or after the fourth birthday. Tdap should be given to children aged 7 to 10 years who did not complete the primary series, and to adolescents older than 10 years and adults who have no history of booster Tdap vaccination.

Chemoprophylaxis using the same regimen for treatment of pertussis should be given to several groups of those exposed to the index case regardless of immunization status, including all household contacts and children in child care. Special efforts should be made to give chemoprophylaxis to those at high risk for severe pertussis, including infants, pregnant women, and those in regular contact with these groups. First-line medications used for chemoprophylaxis include macrolide antibiotics: azithromycin, clarithromycin, and erythromycin. In a pediatric clinical trial, azithromycin was equally effective as erythromycin estolate in treating pertussis, had fewer gastrointestinal effects, was less likely to adversely affect therapy compliance, 39 had a shorter treatment course, and did not interfere with cytochrome p450 metabolism. Azithromycin should be given to infants younger than 6 months because of increased risk of hypertrophic pyloric stenosis associated with erythromycin use in this age group. 40 Alternative treatment can be given with trimethoprim-sulfamethoxazole in case of drug allergy or resistance to macrolides.”

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von König CH. Use of antibiotics in the prevention and treatment of pertussis. Pediatr Infect Dis J. 2005 May;24(5 Suppl):S66-8.

Antibiotics are commonly used for treating confirmed cases of pertussis and also for disease prevention in outbreak situations, and there is little evidence of antibiotic resistance of Bordetella pertussis. The most commonly used antibiotic is erythromycin, but the associated side effects limit compliance and therefore efficacy. Other antibiotics, such as clarithromycin and azithromycin, have been shown to be at least as effective as erythromycin in preventing and treating pertussis, and they also have fewer side effects, which improves compliance. This article outlines the use of different antibiotics in pertussis management and their effect on preventing disease transmission and reducing disease severity and duration

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