UMEM Educational Pearls

Title: Pertussis (submitted by Andy Windsor, MD)

Keywords: vaccination, whooping cough (PubMed Search)

Posted: 8/17/2012 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

If you have a patient who meets (or has had close exposure to someone meeting) the clinical case definition of pertussis (a cough lasting at least 2 weeks with one of the following: paroxysms of coughing, inspiratory “whoop,” or post-tussive vomiting) here are some important points to keep in mind:

Vaccination

Be wary that children younger than 7 might not be “up to date” for pertussis vaccination.
- The recommended schedule is four primary doses of DTap at 2, 4, 6 and 15-18 months, and a fifth DTap booster at 4- 6 years old. ACIP now recommends kids 7 and older get a Tdap booster if their immunizations were previously incomplete.

Testing

The available testing modalities for routine surveillance are culture and/or PCR (from a posterior nasopharyngeal swab or aspirate) and serologic testing.
- Serologic results are not currently accepted as laboratory confirmation for purposes of national surveillance, but may be more useful for testing patients in the convalescent stage.

Treatment

The CDC recommends treatment of clinical or confirmed cases with one of these regimens:
- Azithromycin daily x 5 days
- Clarithromycin BID x 7 days
- Erythromycin QID x 14 days
- Trimethoprim/sulfamethoxazole (Bactrim) BID x 14 days if resistance or allergy to macrolides
  - However, a 2011-updated Cochrane review showed that short-term antibiotics (azithromycin for 3-5 days, or clarithromycin or erythromycin for 7 days) were as effective as long-term (erythromycin for 10-14 days) (RR 1.01) (95% CI 0.98-1.04). Trimethoprim/sulfamethoxazole for seven days was also effective.
Insufficient evidence to decide whether there is clear benefit for treating healthy contacts, but the CDC does recommend prophylactic treatment of close contacts and family members.

References:

Altunaiji SM, Kukuruzovic RH, Curtis NC, Massie J. Antibiotics for whooping cough (pertussis). Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004404. DOI: 10.1002/14651858.CD004404.pub3

http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.html