[Pertussis chemoprophylaxis: a sterile effort?]

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Context:

• Pertussis, caused by Bordetella pertussis, poses significant risks to vulnerable populations, including infants, the elderly, and those with underlying health conditions.
• Transmission occurs via respiratory droplets, with potential for spread beyond 1.5 meters, necessitating careful consideration during outbreaks, especially in healthcare settings.

Purpose:

• To define the indications and efficacy of pertussis chemoprophylaxis (PChP) for individuals at high risk of severe complications or death from Bordetella pertussis infection.
• To review the evidence supporting the use of specific antibiotic classes for PChP and establish recommended treatment durations.

Summary:

• Pertussis chemoprophylaxis is advised for high-risk contacts of infected individuals, particularly within 21 days of symptom onset in the index case, provided no secondary cases arise.
• The recommendation extends to high-risk individuals in institutional settings or those cohabiting with an infected person.
• Macrolides (erythromycin, clarithromycin) and azalides (azithromycin) are effective PChP agents, with recommended durations of 7 days for erythromycin/clarithromycin and 5 days for azithromycin.

Impact:

• Chemoprophylaxis plays a crucial role in preventing severe pertussis outcomes and limiting transmission in at-risk populations and during outbreaks.
• Evidence-based guidelines for PChP contribute to improved patient management and public health strategies for pertussis control.