Key points
- Treatment within the first 1-2 weeks is most effective for reducing symptom severity.
- Healthcare providers should consider treating prior to test results if certain circumstances are present.
- Choosing the type of antibiotic to use may depend on a number of factors, including age.
Early treatment can reduce severity
The earlier someone, especially an infant, starts treatment the better. If someone starts treatment during the first 1 to 2 weeks before coughing paroxysms occur, symptoms may be lessened.
Antibiotics won't alter the course of the illness or prevent transmission if given later in the illness.
Consider treating prior to test results
Healthcare providers should strongly consider treating prior to test results if any of the following are present:
- Clinical history is strongly suggestive of pertussis
- Person is at high risk for severe or complicated disease
- Person has or will have contact with someone at high risk for severe disease
Infants are a high-risk group, as are pregnant women in their third trimester since they'll have contact with their newborn.
Treatment timeline
A reasonable guideline is to treat
- People 1 year of age and older within 3 weeks of cough onset
- Infants younger than 1 year of age within 6 weeks of cough onset
- Pregnant women (especially if near term) within 6 weeks of cough onset
Postexposure Antimicrobial Prophylaxis
Antibiotic choice
The recommended antibiotics for treatment or postexposure prophylaxis of pertussis are
- AzithromycinA
- Clarithromycin
- Erythromycin
Healthcare providers can also use trimethoprim-sulfamethoxasole.
Important considerations
Healthcare providers should choose an antibiotic after consideration that includes the
- Potential for adverse events and drug interactions
- Tolerability
- Ease of adherence to the regimen prescribed
- Cost
Treatment options vary by age
Infants less than 1 month of age
Use macrolides with caution. An association between orally administered erythromycin and azithromycin with infantile hypertrophic pyloric stenosis (IHPS) has been reported.
However, azithromycinA remains the drug of choice for treatment or prophylaxis of pertussis in very young infants. The risk of developing severe pertussis and life-threatening complications outweighs the potential risk of IHPS.
Monitor infants <1 month of age who receive a macrolide for the development of IHPS and for other serious adverse events.
People 1 month of age and older
Macrolides (erythromycin, clarithromycin, and azithromycin) are preferred for the treatment of pertussis.
People 2 months of age and older
An alternative to macrolides is trimethoprim-sulfamethoxazole.
- 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: Patients with known prolongation of the QT interval, a history of torsades de pointes, congenital long QT syndrome, bradyarrhythmias, or uncompensated heart failure. Patients on drugs known to prolong the QT interval. 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. Elderly patients and patients with cardiac disease may be more susceptible to the effects of arrhythmogenic drugs on the QT interval.