Pertussis Information for Health Professionals
- Pertussis Information for Health Professionals Home
- Managing Pertussis: Think, Test, Treat & Stop Transmission
- Pertussis Clinical Information
- Pertussis - Laboratory Testing
- Pertussis Treatment and Prophylaxis
- Follow-up Recommendations for Pertussis Exposures in the Health Care Setting
- Reporting Pertussis
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Pertussis Treatment and Prophylaxis
Antimicrobials are recommended for the treatment of pertussis cases and prophylaxis for some case contacts. The same regimen is used for both.
- Cases should be treated as early as possible in the course of illness. Pertussis is toxin-mediated, so symptoms do not necessarily resolve with treatment. If treatment is started early (during the catarrhal stage), they may be lessened. Cases will become noninfectious after completing five days of antibiotic treatment.
- Treatment initiated more than three weeks after onset of illness isn't generally recommended because viable bacteria is likely no longer present. However, infants are at highest risk of complications and severe disease, therefore treatment is recommended for:
- 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.
- In certain situations, close contacts of pertussis cases may be treated with antimicrobials to prevent infection. Prophylaxis should be initiated as soon as possible within 21 days (the maximum incubation period for pertussis) of exposure to an infectious case. Prophylaxis is generally limited to:
- Household members if the index case in the household has been coughing for less than 21 days.
- Persons at high-risk for severe pertussis: Infants <12 months, pregnant women (especially those in the third trimester), and those with a pre-existing condition that may be exacerbated by a pertussis infection.
- Persons in contact with those at high-risk for severe pertussis (such as child care staff that work with infants).
- Health care workers who have unprotected exposure and are likely to expose those at high-risk for severe pertussis (such as NICU staff).
- Other situations as appropriate in limited settings and as recommended by public health.
- For more information refer to CDC: Treatment of Pertussis.
Antibiotic treatment and prophylaxis
Note: All three macrolides are now considered equally appropriate as first line agents for the treatment or prophylaxis of pertussis for persons 6 months of age and older. See specifics for infants < 6 months.
| Drug | Infant (< 6 months of age) | Child (> 6 months of age) | Adult |
|---|---|---|---|
| Azithromycin [1,4] (3-day course not yet approved for treatment of pertussis) | 1-5 months: 10 mg/kg/day orally daily for 5 days <1 month of age: same as above and is the preferred choice for infants <1 month old | 10 mg/kg/day orally on the first day (maximum 500 mg), 5 mg/kg once daily on days 2-5 (maximum 250 mg/day) | 500 mg orally on the first day, 250 mg once daily on days 2-5 |
| Clarithromycin [2,4] Not recommended for use in pregnant women | not recommended for use in infants <6 months of age; see child dose for infants >6 months of age | 15 mg/kg/day orally divided into 2 doses/day for 7 days (maximum 1 g/day) | 500 mg twice daily for 7 days |
| Erythromycin [1,3,4] | Estolate preparation preferred if available 1-5 months: 40-50 mg/kg/day orally divided into 4 doses/day for 14 days (maximum 2 g/day) <1 month of age: same as above but should only be used as an alternate drug. Drug use is associated with elevated risk of IHPS | 40-50 mg/kg/day orally divided into 4 doses/day for 14 days (maximum 2 g/day) | 2 g/day orally divided into 4 doses/day for 14 days |
| Trimethoprim- Sulfamethoxazole [2,4] For those not able to tolerate macrolides. Not recommended for use in pregnant or nursing women | not recommended for use in children <2 months of age; see child dose for infants >2 months of age | 8 mg TMP/40 mg SMX/kg/day orally divided into 2 doses/day for 14 days (maximum 320mg TMP/1600mg SMX/ day) | 320 mg TMP/1600 mg SMX per day orally divided into 2 doses/day for 14 days |
1. FDA Pregnancy Category B drug
2. FDA Pregnancy Category C drug
3. Some authorities prefer the estolate preparation for children but recommend avoiding its use in adults and pregnant women
4. Source: Centers for Disease and Control. Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis. Centers for Disease Control and Prevention: Atlanta, GA, 2005.