Friday, December 11, 2015

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

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