Pertussis Treatment Chart

Recommended Actions for Treating Patients Exposed to Pertussis and Members of their Households

• Persons with symptoms of pertussis, and members of their household, should be treated according to the table below, unless medically contraindicated.
  
  

  Recommended antimicrobial treatment and postexposure prophylaxis for pertussis, by age group

  Age Group	Primary Agents Azithromycin	Alternate agent Erythromycin	Primary Agents Clarithromycin	Primary Agents TMP-SMZ
  < 1 month	Recommended agent. 10mg/kg per day in a single dose for 5 days (only limited safety data available)	Not preferred. Erythromycin is associated with infantile hypertropic pyloric stenosis. Use if azithromycin is unavailable; 40-50 mg/kg per day in 4 divided doses for 14 days	Not recommended (safety date unavailable)	Contraindicated for infants aged < 2months (risk for kernicterus)
  1-5 months	10 mg/kg per day in a single dose for 5 days	40-50 mg/kg per day in 4 divided doses for 14 days	15 mg/kg per day in 2 divided doses for 7 days	Contraindicated at aged < 2 months. For infants aged ≥ 2 months, TMP 8 mg/kg per day, SMZ 40 mg/kg per day in 2 divided doses for 14 days
  Infants (aged ≥ 6 months) and children	10 mg/kg in a single dose on day 1 then 5 mg/kg per day (maximum: 500 mg) on days 2-5	40-50 mg/kg per day (maximum: 2 g per day) in 4 divided doses for 14 days	15 mg/kg per day in 2 divided doses (maximum: 1 g per day) for 7 days	TMP 8 mg/kg per day, SMZ 40mg/kg per day in 2 divided doses for 14 days
  Adults	500 mg in a single dose on day 1 then 250 mg per day on days 2-5	2 g per day in 4 divided doses for 14 days	1g per dy in 2 divided doses for 7 days	TMP 320 mg per day, SMZ 1,600 mg per day in 2 divided doses for 14 days
  Trimethroprim sulfamethoxazole (TMP-SMZ) can be used as an alternative agent to macrolides in patients aged >2 months who are allergic to macrolides, who cannot tolerate macrolides, or who are infected with a rare macrolide-resistant strain of Bordetella pertussis. Table is from MMWR, December 9, 2005, Vol54/No. RR 14, Recommended Antimicrobial Agents for Treatment and Postexposure Prophylaxis of Pertussis.

• Obtain a nasopharyngeal specimen for culture from the posterior nasopharynx preferably within 2 weeks of cough onset. A positive culture confirms diagnosis of pertussis, but a negative result does not rule out pertussis since the sensitivity of culture is not high. PCR testing of nasopharyngeal swabs is available from the Public Health Laboratory.
• Advise symptomatic patients to stay at home for at least the first 5 days of antibiotics.
• All household contacts of cases should receive antibiotics whether or not they have symptoms and irrespective of their immunization history.
• All contacts < 7 years old who have not received at least 4 doses of DtaP, or for whom it has been over 3 years since the last dose, should receive a DtaP dose. (DtaP doses should be spaced by 4 weeks).
• All contacts 10 - 64 years old should receive one dose of Tdap.