Expert consensus for pertussis in children: new concepts in diagnosis and treatment
Yu-Mei Mi1, Ji-Kui Deng2, Ting Zhang3
1Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
Insights
Pertussis is resurging globally, impacting children and adults. This expert consensus offers updated guidance on diagnosing and treating pertussis, addressing challenges like antibiotic resistance in Bordetella pertussis.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Public Health
Background:
- Pertussis (whooping cough) resurgence observed globally over the past two decades.
- Challenges in control despite universal childhood vaccination, possibly due to waning immunity or Bordetella pertussis mutations.
- Shifting disease burden to school-aged children and adults, who act as reservoirs for infant infections.
Purpose of the Study:
- To develop an expert consensus providing updated concepts for the diagnosis and treatment of pertussis in clinical practice.
- To address the growing challenge of erythromycin-resistant Bordetella pertussis (ERBP) in China.
- To offer a comprehensive reference for healthcare professionals managing pediatric pertussis cases.
Main Methods:
- Expert panel convened to review clinical evidence, experiences, and existing guidelines.
- Systematic literature review conducted across multiple databases (PubMed, Cochrane, EMBASE, etc.) up to May 2024.
- Development of recommendations through open-ended discussions based on collected evidence.
Main Results:
- A diagnostic and treatment flow diagram for pertussis was established.
- Diagnostic criteria, high-risk case identification, and severe pertussis assessment were detailed.
- Treatment recommendations include macrolides for erythromycin-sensitive B. pertussis (ESBP), trimethoprim-sulfamethoxazole for children over two months, and intravenous piperacillin or cefoperazone-sulbactam for infants and severe cases.
Conclusions:
- The expert consensus provides crucial guidance for the diagnosis and treatment of pertussis in children.
- Addresses the clinical management of both antibiotic-sensitive and resistant Bordetella pertussis strains.
- Aims to improve pertussis prevention, diagnosis, and management strategies in clinical settings.
Background:
Pertussis resurgence has been reported worldwide in the past two decades. Pertussis is still endemic and difficult to control though with universal vaccination in children. The resurgence may be related to multiple variables, such as increased disease awareness and laboratory tests, waning of immunity following vaccination, and/or genetic mutations of Bordetella pertussis. For better pertussis prevention, diagnosis, and management, we called up an expert panel to develop this expert consensus to provide new concepts in diagnosis and treatment for clinical practice.
Data Sources:
The expert groups collected clinical evidence, summarized their clinical experiences, evaluated preliminary recommendations or guidelines, and then organized open-ended discussions to form the recommendations. This consensus was developed by reviewing the literature and studies in databases, including PubMed, Cochrane, EMBASE, the China Biomedical Database, and the Chinese Journal Full-text Database up to May 2024. The search terms included "pertussis" or "whooping cough", "children", "diagnosis", and "treatment".
Results:
The burden of pertussis has also changed from infants to school children and adults, and these age groups have consequently become the main source of infection for vulnerable population including infants and newborns. In China, a high prevalence of erythromycin-resistant Bordetella pertussis (ERBP) has been reported in the past decade. ERBP may lead to failed clinical empirical treatment with macrolides, which poses a great challenge for pertussis management and control. For better management of pertussis, a flow diagram for diagnosis and treatment of pertussis was presented in this consensus. This consensus also described the diagnostic criteria for pertussis, high-risk cases, and severe pertussis. Macrolides can still be used to treat confirmed erythromycin-sensitive B. pertussis (ESBP) infections, whereas oral trimethoprim-sulfamethoxazole therapy is the initial treatment option for children older than two months. For infants younger than two months, severe patients, or those exhibiting a high degree of sulfonamide allergy, intravenous administration of piperacillin or cefoperazone-sulbactam is advised.
Conclusions:
This expert consensus provides a comprehensive guidance and a reference for the diagnosis and treatment of pertussis in children.
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