Treatment is largely symptomatic.
Hospital admission is necessary for all infants under 6 months of age and for any older child who has had apnoeic or cyanotic spells.
Children with suspected, epidemiologically linked or confirmed pertussis should be excluded from schools or nurseries for 48 hours following commencement of recommended antibiotic therapy or for 21 days from onset of symptoms (in those who are not treated) (1).
Antibiotic treatment in whooping cough is recommended for suspected, epidemiologically linked or confirmed cases (1):
- should be administered as soon as possible after onset of illness to eradicate the organism and limit ongoing transmission
- treatment with antibiotics is recommended within three weeks of onset of illness (if given late, the effect of treatment on reducing symptoms is limited)
- effective regimens include:
- neonates (<1 month):
- clarithromycin - preferred agent
- azithromycin - may be used although there are limited data in this age group
- infants (1 month - 12 months):
- azithromycin and clarithromycin are the preferred antibiotics
- children over 1 year and adults:
- azithromycin and clarithromycin are the preferred antibiotics
- for individuals in whom macrolides are contra-indicated or not tolerated, co-trimoxazole may be used although this is not licensed for chemophrophylaxis
- pregnant women:
- erythromycin is the preferred antibiotic for treating women in the last month of pregnancy to prevent ongoing transmission to their infant
- treatment with erythromycin earlier in pregnancy should be a clinical decision based on the likely clinical benefit for the woman (1).
- secondary bronchopneumonia should be treated according to the organism cultured
Oxygen should be given if there is cyanosis. Mild sedation may be necessary for frequent spasms. Fluid and nutritional status should be monitored.
Steroids are said to reduce the severity of the disease but their role in management is not yet proven.
Immunization:
- unimmunised / partially vaccinated cases up to 10 years:
- complete primary and booster immunisation if unvaccinated / incompletely immunised once recovered
- pregnant women diagnosed with pertussis (at any stage of pregnancy) and have not been vaccinated after 16 weeks of pregnancy should still be offered a dose of pertussis-containing vaccine; those diagnosed before 16 weeks gestation should wait until they reach 16 weeks of pregnancy to have the vaccine (1)
References: