Staying ahead of pertussis

A macrolide antibiotic is generally used to treat pertussis (TABLE 4).^25-30 Consider starting treatment before lab results are
 in when clinicial suspicion is high and the patient may be in contact with high-risk individuals. Erythromycin had been the drug of choice, but recent studies have found similar efficacy for azithromycin and clarithromycin.²⁹ For infants younger than one month of age, azithromycin is preferred because in addition to being as effective as other macrolides, it has a better adverse effect profile.²⁹ For patients who are at least 2 months of age, trimethoprim-sulfamethoxazole is an acceptable alternative to a macrolide.

The CDC recommends that any adolescent or adult who has a cough and has had close contact with an individual with a laboratory-confirmed case of pertussis within the past 21 days should be treated.³⁰ Close contacts younger than 7 years of age who have not received the first 4 doses of the pertussis vaccine should be offered treatment.

CORRESPONDENCE
Gary Rivard, DO, Family Medicine Residency Program, Central Maine Medical Center, 76 High Street, Lewiston, ME 04282; rivardga@cmhc.org