Medication Summary
Antimicrobial agents given during the catarrhal phase may ameliorate the disease. Once cough is established, antimicrobial agents may not alter the course of the illness but still are recommended to limit the spread of disease.
Pertussis-specific immunoglobulin is an investigational product that may be effective in decreasing paroxysms of cough, although it requires further evaluation.
The use of corticosteroids, albuterol, and other beta2-adrenergic agents for the treatment of pertussis is not supported by controlled, prospective data.
Antibiotics, Other
Class Summary
The Committee on Infectious Diseases (COID) of the American Academy of Pediatrics (Red Book Committee) recommends promptly treating all household and other close contacts (eg, children and staff at daycare centers) with erythromycin to limit secondary transmission. [44] This is regardless of the age or immunization status of contacts.
A 14-day course of oral erythromycin is the antimicrobial therapy of choice for patients with pertussis and for close contacts. Typical dosing schedule is 40-50 mg/kg/day (not to exceed 2 g/day) in 4 divided doses. Some experts prefer the estolate preparation in young infants because of more effective absorption, which may lead to decreased dosing and less frequent dosing intervals.
Erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin)
Erythromycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest.
Erythromycin estolate is the antibiotic of choice to prevent interpersonal transfer, because of enhanced absorption, particularly in young infants. (Its effectiveness in prophylaxis for exposed and susceptible persons has not been determined.)
Erythromycin is recommended for household and close contacts (50 mg/kg/day PO qid for 14 days). It is effective in reducing the course and symptoms of pertussis if it is started within the first 10-14 days, but its efficacy has not been proven beyond this period.
Azithromycin (Zithromax, Zmax)
Azithromycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It has been shown in several small studies to be effective against pertussis.
Clarithromycin (Biaxin)
Clarithromycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It has been shown in small studies to be effective against pertussis.
Trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra DS)
This agent inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. It can be used as an alternative treatment.
Vaccines, Inactivated, Bacterial
Class Summary
Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components that act as antigens. Administration of the vaccine stimulates the production of antibodies with specific protective properties.
The need for prevention of pertussis through immunization cannot be overemphasized. All children younger than 7 years should receive the pertussis vaccine. In the United States, acellular pertussis vaccine is recommended and usually is combined with diphtheria and tetanus toxoids (DTaP). When possible, the same DTaP vaccine product should be used for the first 3 doses of the pertussis immunization series. Reduced-volume dosing is not recommended. Measurable antibody wanes after 3-5 years and is not measurable 12 years after vaccination has been completed. The vaccine may not prevent the illness entirely, but it has been shown to lessen disease severity and duration.
Adolescents and adults have been identified as the source of pertussis transmission to infants, from household contact studies and outbreak investigations. In February 2012, the CDC Advisory Committee on Immunization Practices (ACIP) recommended the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine for all adults, including those aged 65 years or older, and pregnant women.
A Cochrane Database of Systematic Reviews study comparing the safety and efficacy of whole-cell pertussis vaccines with acellular pertussis vaccines in children up to age 6 years found that not only are multi-component acellular pertussis vaccines effective, they show less adverse effects than whole-cell vaccines for primary and booster doses. [45]
The American Academy of Pediatrics approved recommendations from the Committee on Infectious Diseases (COID) for universal vaccination of adolescents at the 11-year or 12-year visit to boost protection against pertussis. [34, 35] The FDA has licensed 2 Tdap vaccines for use in patients aged 10 years or older (Boostrix; GlaxoSmithKline Biologicals, Rixensart, Belgium) and those aged 10-64 years (Adacel; Sanofi Pasteur, Toronto, Canada). Tdap has replaced tetanus in the childhood and adult immunization schedules. It has been shown to be effective in outbreaks in the short term. Long-term effectiveness studies are ongoing.
Compared with children who have been vaccinated, children of parents who refuse pertussis immunizations are at high risk for pertussis infection. A case-control study identified 156 laboratory-confirmed pertussis cases over an 11-year period (matched controls n=595). [46] Among the cases, 18 (12%) children did not receive the pertussis vaccine; among the controls, 3 (0.5%) children did not receive the pertussis vaccine. A secondary case-control analysis confirmed these results.
The study was performed within the Kaiser Permanente system of Colorado, where 11% of all pertussis cases within the system were attributed to parental vaccine refusal. Herd immunity does not seem to completely protect unvaccinated children from pertussis.
The latest vaccine recommendations can be found at the CDC Immunization Schedule Website. [47]
Diphtheria & tetanus toxoids/ acellular pertussis vaccine (Daptacel, Infanrix)
DTaP (Daptacel, Infanrix) promotes active immunity to diphtheria, tetanus, and pertussis by inducing production of specific antibodies and antitoxins.
In children and adults, DTaP may be administered into the deltoid or midlateral thigh muscles. In infants, the preferred site of administration is the mid-thigh, laterally.
Tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine (Adacel, Boostrix, Tdap)
Promotes active immunity to diphtheria, tetanus, and pertussis by inducing the production of specific neutralizing antibodies and antitoxins. It is indicated for active booster immunization for persons aged 10 or older (Adacel approved for aged 10-64 y, Boostrix approved for aged 10 y or older). It is the preferred vaccine for adolescents scheduled for a booster vaccination.
It also is indicated to prevent pertussis in infants younger than 2 months by immunizing pregnant females during the third trimester of pregnancy.
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A photomicrograph of the bacterium Bordetella pertussis, using Gram stain technique.
