Antibiotics for whooping cough (pertussis)

Area of Science:

• Infectious Diseases
• Microbiology
• Pharmacology

Background:

• Whooping cough (pertussis) is a highly contagious disease posing the greatest risk of severe illness and death in infants.
• Current 14-day erythromycin treatment and prophylaxis regimens are lengthy and inconvenient, with uncertain benefits for prophylaxis.

Purpose of the Study:

• To evaluate the efficacy and safety of various antibiotic treatments for whooping cough.
• To assess the benefits and risks of antibiotic contact prophylaxis against pertussis.

Main Methods:

• Systematic review of randomized and quasi-randomized controlled trials.
• Searched multiple databases (CENTRAL, MEDLINE, EMBASE) and other sources for published and unpublished studies.
• Independent data extraction and quality assessment by at least three reviewers.

Main Results:

• Short-term antibiotic regimens (3-day azithromycin, 7-day clarithromycin, 7-day erythromycin estolate) were as effective as 14-day regimens in eradicating Bordetella pertussis (B. pertussis).
• Short-term treatments resulted in significantly fewer side effects compared to long-term regimens.
• Antibiotic prophylaxis for pertussis contacts did not significantly reduce clinical symptoms or culture-positive B. pertussis cases.

Conclusions:

• Antibiotics effectively eliminate B. pertussis, rendering patients non-infectious, but do not alter the clinical course of the illness.
• Three days of azithromycin or seven days of clarithromycin are recommended as optimal treatment regimens due to efficacy and safety.
• Evidence is insufficient to support the benefit of prophylactic antibiotic treatment for pertussis contacts.