Availability in Hospital Keningau
- Azithromycin 250mg
- Clarithromycin 250mg
- Erithromycin 400mg
- Bactrim
High Risk Groups:
- The need for prophylaxis in the
following high risk groups is particularly important infants
- non-immunized children
- immuno-compromised individuals
- pregnant women
- individuals with chronic respiratory
illness, including asthmatics
Treat /give prophylaxis to close
contacts of case with the following as a guide:
- If symptomatic people are already beyond their infectious period, which
ends 21 day after cough onset, treatment is not of use. However they should be
referred for medical evaluation.
- For asymptomatic individual, if their last exposure occurred beyond 21
days, prophylaxis is not needed.
Table 1: Antimicrobial Agents for
Treatment and Prophylaxis of Pertussis
Drug
|
Infant<6months
|
INFANT ≥6
MONTHS AND
CHILDREN
|
Adults
|
Erythromycin (stearate)
|
< 30 days of age:
not preferred as it is
associated with infantile
hypertrophic pyloric
stenosis, Use if azithromycin is
unavailable. Dosage
is 40 – 50 mg/kg per
day in 4 divided
doses for 14 days.
1 – 5 months of
age: 40-50 mg/kg/day divided into 4
doses, for 14 days.
|
40-50 mg/kg/day in
4 divided doses, for
14 days (maximum
2 g/day)
|
2 g/day in 4 divided
doses, for 14 days.
|
Erythromycin Ethyl Succinate
|
|
80-100 mg/kg/day divided into q8hr or
q6hr dosing for 14 days
|
400 mg four times a day for 14 days
for 14 days*
|
Clarithromycin
For those unable to
tolerate
erythromycin.
Not recommended
during pregnancy.
|
Not recommended
for use in infants <1
month of age; for
infants >1 month of
age use child dose.
|
15 mg/kg/day
divided into 2
doses, for 7 days
(maximum 1 g/day).
|
1 g per day in 2
divided doses for a
minimum of 7 days.
|
Azithromycin
5-day course.
For those unable to
tolerate
erythromycin.
|
Preferred antimicrobial
for use in
children <1 month
of age; 10 mg/kg
per day in a single
dose for 5 days.
for infants >1
months of ag; 10
mg/kg/day in a
single dose for 5
days
|
10 mg/kg/day on the
first day, then 5
mg/kg once daily for
next 5 days
(maximum 500 mg).
|
500 mg on the first
day, then 250 mg
once daily for next 5
days.
|
Trimethoprim-
Sulfamethoxazole
(Bactrim®, Septra®)
|
Should not be used
for children <2
month of age (risk
of kernicterus);
for infants >2
|
TMP 8 mg/ kg per
day, SMZ 40 mg/
kg/day in 2 divided
doses, for 14 days.
|
TMP 320 mg per
day, SMZ 1600 mg
per day in 2 divided
doses, for 14 days.
|
*based on pharmakinetic and product recomendation, an alternative dosing to EES 400mg QID is 800mg BD
Caution
- Macrolides
taken by pregnant or breastfeeding mothers have been reported with
- an
increased risk of infantile pyloric stenosis. The risk is presumed to be lower
for azithromycin than for erythromycin;
- however
there have been reports in the literature of pyloric stenosis in infants of
women treated in pregnancy with azithromycin.
- Inform patients to contact their doctor if vomiting or irritability with
feeding occurs.
Therapy Rationale
- In
a 2007 Cochrane systematic review of antibiotics for pertussis, the authors
concluded that although
antibiotic therapy for cases was effective in eliminating B. pertussis, it
did not alter thesubsequent
clinical course of the illness.
- Short
term use (azithromycin for 3–5 days; clarithromycin or erythromycin for seven
days) was as effective as erythromycin for 10–14 days in eradicating B.
pertussis from the nasopharynx and had fewer side effects
References:
- CASE INVESTIGATION AND OUTBREAK
MANAGEMENT FOR HEALTHCARE PERSONNEL: PERTUSSIS 2010
- https://www.cdc.gov/vaccines/vpd/pertussis/tdap-revac-hcp.html
- http://www.webmd.com/children/vaccines/dtap-and-tdap-vaccines#1
- Guidelines
for the Public Health Management of Pertussis Public Health Medicine
Communicable Disease Group HSE. October 2013
- Pertussis
Antibiotic Recommendations for Treatment and Prophylaxis. Milwaukee Health Dept
(2004)
- Health
Professionals Advice: Azithromycin now fully funded. 3 December 2012
- National
Antibiotic Guideline, 2014
