Treating Pertussis: CDC Guidance for Clinicians

Pertussis is treated with antibiotics — and timing matters. CDC's guidance for health care providers covers who to treat, when, and with which drugs.

Treat early

The earlier treatment starts — especially in infants — the better. Treatment in the first 1 to 2 weeks, before the coughing fits (paroxysms) begin, may lessen symptoms. Given later in the illness, antibiotics won't change its course or prevent it from spreading.

Don't always wait for test results

Providers should strongly consider treating before test results come back if:

• the person's clinical history strongly suggests pertussis;
• the person is at high risk of severe or complicated disease;
• the person has, or will have, contact with someone at high risk of severe disease.

Infants are a high-risk group, and so are pregnant women in their third trimester, who will soon be in contact with their newborn.

How long after cough onset to treat

A reasonable guideline is to treat:

• people 1 year and older within 3 weeks of cough onset;
• infants under 1 year within 6 weeks of cough onset;
• pregnant women, especially near term, within 6 weeks of cough onset.

Preventing illness in contacts

CDC supports postexposure prophylaxis (PEP) — preventive antibiotics — for people at high risk of severe pertussis and their close contacts.

Choosing an antibiotic

The recommended antibiotics for treatment or PEP are:

• macrolides — azithromycin, clarithromycin and erythromycin;
• trimethoprim-sulfamethoxazole.

Choose after weighing possible side effects and drug interactions, how well the patient will tolerate the drug and stick to the regimen, cost, and any travel in the past 21 days to a region where macrolide resistance is common.

CDC's 2005 guidelines on recommended antimicrobial agents for treating and preventing pertussis give further detail.

Sources

• Centers for Disease Control and Prevention: "Treatment of Pertussis"; a work of the United States government in the public domain.