Treatment of Pertussis in children

Availability:
Azithromycin 250mg tab, 200mg/5ml granules
Erythromycin ethylsuccinate  400mg Tab, 200mg/5ml suspension

Clarithromycin 250mg tab               

Trimethoprim/Sulfamethoxazole( 400/80 mg) tab, (200mg/40mg)/5ml suspension

Management

• Mainstay of treatment is supportive therapy

• Pharmacological options:

      -Preferred antimicrobial regimen is based on age.
      -Early treatment leads to faster resolution of symptoms, suggest to treat those
       with clinical symptoms with or without confirmation.

First line agent
Azithromycin	Age	Dosing
	Infant <1month Infant(1-5 months) Infant >6 months & children	10mg/kg/day in single dose for 5 days 10mg/kg/day in single dose for 5 days 10mg/kg/day on day 1, then 5mg/kg/day for 2-5 days. Max dose of 500mg.
Erythromycin	Infant <1month Infant(1-5 months) Infant ≥ 6 months & children	Not preferred (assoc with IHPS) 40mg/kg/day in 4 divided doses for 14 days 40mg/kg/day  in 4 divided doses for 14 days  (Max 2000mg/day)
Clarithromycin	Infant <1month Infant(1-5 months) Infant ≥ 6 months & children	Not recommended (safety data unavailable) 15mg/kg/day in 2 divided doses for 7 days 15mg/kg/day in 2 divided doses for 7 days (Max 1g/day)
Alternative agent (when intolerant/ contraindicated to macrolides)
Trimethoprim/ Sulfamethoxazole	Infant <2 months Infant  ≥ 2months & children	Contraindicated (risk of kernicterus) TMP/SMX (8/40 mg/kg/day) in 2 divided doses for 7 days

Precautions

• Macrolides are associated with risk of infantile hypertrophic pyloric stenosis (IHPS). Azithromycin has not been associated with infantile hypertrophic pyloric stenosis (IHPS), preferred for infant aged <1 y/o.

• Monitor for development of IHPS in infants <1 year old

 References:

1. Up-To-Date

2. Sanford

3. http://www.cdc.gov/pertussis/clinical/treatment.html