Treatment and Management of Pertussis

Medical care
The mainstay of therapy in patients with active pertussis infections is supportive. The goals of therapy include limiting the number of paroxysms, observing the severity of cough, providing assistance when necessary, and maximizing nutrition, rest, and recovery.

• Although antimicrobial agents initiated during the paroxysmal stage do not affect the duration and severity of illness, they can hasten the eradication of Bordetella pertussis in the respiratory tract and help prevent spread.

• For patients aged 1 month or older, macrolide antibiotics such as erythromycin, clarithromycin, and azithromycin, are the preferred agents.

• Erythromycin and clarithromycin are not recommended in infants younger than 1 month because their use has been associated with increased risk for infantile hypertrophic pyloric stenosis (IHPS).

• Azithromycin, which also carries some risk for IHPS, is the recommended agent in the youngest patients. Patients who are aged 2 months or older with hypersensitivity to macrolides may be treated with trimethoprim-sulfamethoxazole.

• Hospitalization should be strongly considered for patients at risk of severe disease and complications, including infants younger than 3 months; infants aged 3-6 months, unless observed paroxysms are not severe; premature young infants; and infants or children with underlying pulmonary, cardiac, or neuromuscular disease.
o For the hospitalized patient, in addition to standard precautions, droplet precautions are recommended for 5 days after initiation of effective therapy or until 3 weeks after the onset of paroxysms if appropriate antimicrobial therapy is not given.
o Monitor heart rate, respiratory rate, and oxygen saturation of hospitalized patients continuously, especially in relation to coughing paroxysms. Coughing, feeding, vomiting, and weight changes should be recorded.
o Pay attention to the young infant's hydration and nutritional status.
o Patients who are severely ill may require treatment in an ICU.

Medication
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 are still recommended to limit the spread of disease.

Pertussis-specific immune globulin is an investigational product that may be effective in decreasing paroxysms of cough but 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
The Committee on Infectious Diseases of the American Academy of Pediatrics (Red Book Committee) currently recommends promptly treating all household and other close contacts (eg, children and staff at daycare centers) with erythromycin to limit secondary transmission.12 This is regardless of the age or immunization status of contacts. A 14-day course of oral (PO) erythromycin is the antimicrobial therapy of choice for patients with pertussis and for close contacts. Typical dosing schedule is 40-50 mg/kg/d (not to exceed 2 g/d) 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.
In infants younger than 2 weeks, an association between orally administered erythromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported. Because pertussis can be life threatening in neonates and the efficacy of alternative therapies has not been well studied, the American Academy of Pediatrics continues to recommend the use of erythromycin for treatment of and prophylaxis for pertussis. Parents and caregivers need to be informed about the risks and signs of IHPS.

Click
http://emedicine.medscape.com/article/967268-treatment
and
http://www.nlm.nih.gov/medlineplus/ency/article/001561.htm#Treatment
for more information.