Factors Associated with Time to Appropriate Treatment in Pertussis Cases in Georgia, 2009 to 2013

Pertussis is endemic in the United States, with periodic epidemics that continue to highlight its importance as a public health issue. The clinical presentation of pertussis can vary by age and vaccination status. However, little is known about the factors that affect time to antibiotic treatment of pertussis cases. We analyzed 5 years of data from the Georgia Department of Public Health to understand how factors such as age, symptoms, and vaccination status can alter the clinical picture of pertussis and affect time to treatment. We used multivariable linear regression to assess the impact of each variable on time to antibiotic treatment. There was little consistency across age groups for symptom and demographic predictors of time to antibiotic treatment. Overall, the multivariate linear regression showed that among patients ≤18 years old, none of the variables had an impact on time to antibiotic treatment greater than -0.25 to 1.47 days. Among patients >18 years old, most variables had little impact on time to treatment, though two (paroxysmal cough in >18- to 40-year-olds and hospitalization in individuals over 40) were associated with an additional 5 days in time to treatment from cough onset. This study highlights how the difficulties in pertussis diagnosis, particularly among adults, can affect time to antibiotic treatment; adults may not begin antibiotic treatment until there is an accumulation of symptoms. Health care providers need to recognize the variety of symptoms that pertussis can present with and consider confirmatory testing early.