Pertussis

Pertussis - Acute
Rahul Soman, M. Pharm

 

 

Definition  

An acute and prolonged infectious cough caused by Bordetella pertussis

 

Medical History  

* Pertussis non-immune

* Low birth weight infant

* Occupational Exposure

 

Findings  

* Hacking cough

* Nasal discharge

* Throat irritation

* Pain in throat

* Conjunctival hyperemia

* Paroxysmal cough

* Choking

* Vomiting

* Labored breathing

* Tachypnea

* Apnea

* Cyanosis

* Diaphoresis

* Persistent cough

* Fever

* Seizure

 

Tests  

 

Suspected pertussis  

* Bordetella pertussis culture: Cultures of nasopharyngeal specimens have high specificity but low sensitivity for diagnosis of pertussis .

 

Suspected pertussis  

* Polymerase chain reaction analysis, Bordetella pertussis: According to the CDC, pertussis is diagnosed when a case meets the clinical case definition and is confirmed by a positive polymerase chain reaction (PCR) .

 

Pertussis  

* Complete blood count with white cell differential, automated

 

Suspected pertussis  

* Plain chest X-ray: Chest x-ray abnormalities that may be found in patients with pertussis infection include a "shaggy heart" border and peribronchial thickening.

 

Suspected hypoxia  

* Pulse oximetry: An oxygen saturation of at least 90% is acceptable in most patients .

 

Suspected pertussis  

* Bordetella pertussis direct fluorescent antibody measurement: A positive direct fluorescent antibody assay provides a rapid presumptive diagnosis of pertussis, but poor sensitivity necessitates confirmatory testing .

 

Suspected pertussis  

* Bordetella antibody assay: Serologic assays assist in the retrospective diagnosis of pertussis , but are more often used for surveillance than direct patient care .

 

Differential Diagnosis  

* Respiratory tract infection

* Community acquired pneumonia - Acute

* Bronchiolitis - Acute

* Bronchitis, acute - Acute

* Mycoplasma pneumonia

* Asthma - Acute

* Gastroenteritis - Acute

* Foreign body of airway - Acute

* Cystic fibrosis

* Chlamydia pneumoniae pneumonia

* Tuberculosis - Acute

 

Treatment  

 

Drug Therapy  

 

 

Treatment of pertussis  

 

AZITHROMYCIN  

Adults: 500 mg orally once on day 1, then 250 mg/day orally on days 2 to 5

Pediatrics (<6 months) 10 mg/kg orally once daily for 5 days

Pediatrics (>6 months): 10 mg/kg (maximum, 500 mg) orally in a single dose on day 1, then 5 mg/kg orally (maximum, 250 mg) once daily on days 2 to 5

 

ERYTHROMYCIN  

Adults: 500 mg orally 4 times daily for 14 days

Pediatrics (>1 month): 40 to 50 mg/kg/day orally in 4 divided doses for 14 days (maximum 2 g/day)

 

CLARITHROMYCIN  

Adults: 500 mg orally twice daily for 7 days

Pediatrics (>1 month): 7.5 mg/kg orally twice daily for 7 days (maximum 1 g/day)

 

SULFAMETHOXAZOLE/TRIMETHOPRIM  

Adults (alternative): Trimethoprim 320 mg/day AND sulfamethoxazole 1600 mg/day orally in 2 divided doses for 14 days

Pediatrics (>2 months) (alternative): Trimethoprim 8 mg/kg/day AND sulfamethoxazole 40 mg/kg/day orally in 2 divided doses for 14 days

 

 

Postexposure prophylaxis of close contacts within 3 weeks of exposure, especially in high-risk settings  

 

AZITHROMYCIN  

Adults: 500 mg orally once on day 1, then 250 mg/day orally on days 2 to 5

Pediatrics (<6 months) 10 mg/kg orally once daily for 5 days

Pediatrics (>6 months): 10 mg/kg (maximum, 500 mg) orally in a single dose on day 1, then 5 mg/kg orally (maximum, 250 mg) once daily on days 2 to 5

 

ERYTHROMYCIN  

Adults: 500 mg orally 4 times daily for 14 days

Pediatrics (>1 month): 40 to 50 mg/kg/day orally in 4 divided doses for 14 days (maximum 2 g/day)

 

CLARITHROMYCIN  

Adults: 500 mg orally twice daily for 7 days

Pediatrics (>1 month): 7.5 mg/kg orally twice daily for 7 days (maximum 1 g/day)

 

SULFAMETHOXAZOLE/TRIMETHOPRIM  

Adults (alternative): Trimethoprim 320 mg/day AND sulfamethoxazole 1600 mg/day orally in 2 divided doses for 14 days

Pediatrics (>2 months) (alternative): Trimethoprim 8 mg/kg/day AND sulfamethoxazole 40 mg/kg/day orally in 2 divided doses for 14 days

 

Procedural Therapy  

 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .

 

Suspected or known pertussis in hospitalized patients  

* Isolation of infected patient: Patients with paroxysmal or severe persistent cough during pertussis outbreaks, or with known pertussis should be placed in droplet precaution isolation .

 

Suspected or known pertussis in healthcare personnel  

* Infection control procedure: Healthcare personnel with pertussis symptoms or active infection should be excluded from work duty for 5 days after starting antibiotics .

 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .