Treatment for whooping cough

Pertussis is referred to as “a violent cough” or “the cough of 100 days”, which is also known as whooping cough. 

Treatment of pertussis is mainly supportive, including oxygen, suctioning, hydration, and avoidance of respiratory irritants. Parenteral nutrition might be necessary as the disease may have a prolonged course. However, treatment after 3 weeks of illness may not help. If a patient initiates treatment for pertussis early in the course of disease, during the first 1-2 weeks before coughing paroxysms occur, symptoms might get alleviated.  

As per the Centers for Disease Control and Prevention,

• Children older than 1 year of age should be treated within 3 weeks of cough onset.
• Infants younger than 1 year of age and pregnant women, especially near term must be treated within 6 weeks of cough onset.^[1]

Antibiotic therapy should be considered to decrease the carriage and spread of disease. It should be initiated when 

1. patient is diagnosed in catarrhal or early paroxysmal phase, 
2. cough persists for less than 14 days, 
3. patient has been admitted to hospital, 
4. if complications arises like pneumonia, cyanosis, apnoea.

Hospitalisation is required for patients with superimposed pneumonia, central nervous system (CNS) complications, hypoxia, or who are unable to tolerate nutrition and hydration by mouth. Children <1 year who are not fully vaccinated and carry the highest risk of morbidity and mortality, should be hospitalised irrespective of symptoms. Neonates must be admitted to an intensive care setting as there is a high risk of developing life-threatening cardiopulmonary complications and arrest.

Recommended antibiotics:

Erythromycin – 40-50 mg/kg/day, maximum 2 g/day, in 2 to 3 divided doses (first-line treatment for pertussis.) 

Azithromycin – 10 mg/kg/day on day 1, followed by 5 mg/kg on days 2 to 5. 

Clarithromycin – 15 mg/kg/day in two divided doses (alternative treatments). 

Trimethoprim-Sulfamethoxazole – 8 mg/kg/day of Trimethoprim (alternative in macrolide-allergic patients).

Macrolides like Erythromycin, Azithromycin, and Clarithromycin are preferred for the treatment of pertussis in children aged ≥ 1 month. For infants of <1 month, macrolides must be used with caution as there is an association between orally administered Erythromycin and Azithromycin with infantile hypertrophic pyloric stenosis (IHPS). However, Azithromycin is the drug of choice for prophylactic treatment of pertussis in very young infants as there is a risk of developing severe pertussis and life-threatening complications outweigh the potential risk of IHPS. Hence, clinicians must monitor infants aged <1 month who receive a macrolide for the development of IHPS and for other serious adverse events. For children aged ≥2 months, an alternative to macrolides is Trimethoprim-Sulfamethoxazole.

Exchange blood transfusion therapy for leukocytosis with lymphocytosis can be considered.