Treatment of Pertussis

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 and antibiotic resistance patterns.
• Find more information below about who to treat, when to treat, and antibiotic selection.

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 Prophylaxis (PEP)

To prevent pertussis, CDC supports PEP with antibiotics for those at high risk of developing severe pertussis and their close contacts.Use PEP to prevent severe pertussis

Antibiotic choice

The recommended antibiotics for treatment or postexposure prophylaxis of pertussis are

• Macrolides (i.e., azithromycin
• Trimethoprim-sulfamethoxazole

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
• Recent travel (≤21 days) to a region where macrolide resistance is common
• Cost

Infants less than 1 month of age

Use macrolides with caution. An association between orally administered erythromycin or azithromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported.

However, azithromycin

Monitor infants 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, particularly when macrolide resistance is suspected or confirmed.

Resource

Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC guidelines

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