Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

infants <1 month of age

1st line – macrolide antibiotic

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ACUTE
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infants <1 month of age
1st line – 

macrolide antibiotic

Antimicrobials should be administered as soon as possible during the catarrhal stage; treatment initiated after paroxysms are established may have no clinical effect. Treatment is recommended for infants who present within 6 weeks of cough onset.[30]​​

Azithromycin is the preferred treatment for infants less than aged 1 month.[10][27]​​ In the US, erythromycin is an alternative. Clarithromycin is not recommended in this age group in the US, but it is the preferred therapy in the UK, where erythromycin is also not recommended for treatment of young infants because of its association with hypertrophic pyloric stenosis. Antibiotic regimens may vary in different locations. Regimens given here are based on US guidance; you should consult your local guidance.

Infants aged under 1 month who receive a macrolide should be monitored for hypertrophic pyloric stenosis.

Treatment prior to test results should be considered if the clinical history is suggestive of pertussis because of the highly transmissible nature of the infection and potential delays in obtaining diagnostic test results.

Doses and regimens used for post-exposure prophylaxis are the same as those for treatment.

Primary options

azithromycin: 10 mg/kg orally once daily for 5 days

Secondary options

clarithromycin: 15 mg/kg/day orally given in 2 divided doses for 7 days

OR

erythromycin base: 40-50 mg/kg/day orally given in 4 divided doses for 14 days

infants and children ≥1 month of age and adults

1st line – macrolide antibiotic or trimethoprim/sulfamethoxazole

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ACUTE
|
infants and children ≥1 month of age and adults
1st line – 

macrolide antibiotic or trimethoprim/sulfamethoxazole

Antimicrobials should be administered as soon as possible during the catarrhal stage; treatment initiated after paroxysms are established may have no clinical effect. Treatment is recommended for patients within 3 weeks of cough onset, and within 6 weeks for pregnant women, immunocompromised people, or people otherwise at high risk of severe pertussis.[30] Treatment prior to test results should be considered if the clinical history is suggestive of pertussis or the patient is at high risk of severe pertussis, because of the highly transmissible nature of the infection and potential delays in obtaining diagnostic test results.

First-line treatment for suspected or confirmed cases is a macrolide antibiotic (azithromycin, clarithromycin, erythromycin).[10][27][30]​​ Azithromycin and clarithromycin are generally preferred because of fewer adverse drug effects and more convenient dosing regimens. Antibiotic regimens may vary in different locations. Regimens given here are based on US guidance; you should consult your local guidance. Clarithromycin should not be used in pregnant women unless the benefits outweigh the risks and no alternative therapy is available.

In the UK, erythromycin is preferred for the treatment of pregnant women; clarithromycin and azithromycin are not recommended.[27]

Trimethoprim/sulfamethoxazole is indicated in people for whom macrolides are contraindicated or not tolerated and in cases of suspected or confirmed macrolide resistance.[10][27]​ An increased risk of congenital malformations following maternal use of trimethoprim/sulfamethoxazole during pregnancy has been observed. It should be used during pregnancy only if the benefits outweigh the risks to the fetus, especially during the first trimester.

Doses and regimens used for post-exposure prophylaxis are the same as those for treatment.

Primary options

azithromycin: children ≥1 month up to 6 months of age: 10 mg/kg orally once daily for 5 days; children ≥6 months of age: 10 mg/kg (maximum 500 mg/dose) orally once daily on first day, followed by 5 mg/kg (maximum 250 mg/dose) once daily for 4 days; adults: 500 mg orally once daily on first day, followed by 250 mg once daily for 4 days

OR

clarithromycin: children ≥1 month of age: 15 mg/kg/day orally given in 2 divided doses for 7 days, maximum 1000 mg/day; adults: 500 mg orally twice daily for 7 days

OR

erythromycin base: children ≥1 month of age: 40-50 mg/kg/day orally given in 4 divided doses for 14 days, maximum 2000 mg/day; adults: 500 mg orally four times daily for 14 days

Secondary options

trimethoprim/sulfamethoxazole: children ≥2 months of age: 8 mg/kg/day orally given in 2 divided doses for 14 days; adults: 160 mg orally twice daily for 14 days

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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