Effect of Early Administration of Clarithromycin or Azithromycin on Symptoms of Pertussis in Infants
Alberto Eugenio Tozzi1, Ileana Croci1, Francesco Gesualdo1
1Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, 00165 Rome, Italy.
Insights
Early macrolide antibiotic treatment for infants with pertussis significantly shortens cough duration and reduces symptom severity. This approach, particularly with clarithromycin, is crucial for managing pertussis resurgence.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Pertussis (whooping cough) resurgence observed post-COVID-19.
- Macrolides are primary antibiotics for pertussis treatment.
- Limited data on early macrolide administration impacts in infants.
Purpose of the Study:
- To evaluate the impact of early vs. late macrolide antibiotic administration on pertussis symptoms in infants.
- To compare the efficacy of clarithromycin and azithromycin in treating infant pertussis.
Main Methods:
- Retrospective cohort study of 148 laboratory-confirmed pertussis cases in infants (2015-2020).
- Comparison of outcomes: early (≤7 days of cough onset) vs. late (≥8 days) macrolide treatment.
- Key outcomes: cough duration, symptom frequency (apnea), complication rates.
Main Results:
- Early antibiotic administration (≤7 days) correlated with significantly shorter cough duration (14 vs. 24 days).
- Infants treated later were three times more likely to experience apnea (p=0.008).
- Clarithromycin showed a trend towards shorter cough duration compared to azithromycin (p=0.030).
Conclusions:
- Early macrolide treatment (clarithromycin or azithromycin) improves clinical outcomes in infant pertussis.
- Clarithromycin may offer superior efficacy in reducing cough duration.
- Early antibiotic intervention is recommended for pertussis resurgence, considering potential benefits versus risks.
Abstract:
Background: A resurgence of pertussis has been observed in several geographic areas in the post-COVID-19 era. Macrolides are the first-choice antibiotics for the treatment of pertussis. Limited data exist on the impact of the early administration of clarithromycin or azithromycin on infants' pertussis symptoms. Methods: This retrospective cohort study analyzed infants enrolled in an enhanced surveillance program for pertussis at a single Italian clinical reference center between 2015 and 2020. All cases were laboratory-confirmed. This study compared outcomes based on the timing of macrolide antibiotic treatment: early administration (within 7 days of cough onset) versus late administration (8 days or later). Key outcomes included cough duration, symptom frequency, and complication rates. Results: We studied 148 infants with confirmed pertussis. The median duration of coughing was 14 days in infants with early administration and 24 days in those with late administration. The occurrence of symptoms differed for apnea (62.6% for early administration; 84.6% for late administration). In a multivariable Cox model, the duration of the cough was lower in infants receiving antibiotics within 7 days from the beginning of the cough compared with those starting later (HR = 0.36, 95% CI: 0.25-0.53, p < 0.001). Clarithromycin was associated with a shorter duration of coughing (HR = 0.42, 95% CI: 0.19-0.92, p = 0.030) independently from other factors. Regarding the occurrence of symptoms, children receiving antibiotics later were three times more likely to experience apnea compared to those treated early (p = 0.008). Conclusions: Early treatment with clarithromycin or azithromycin for infants with pertussis improves clinical symptoms. Clarithromycin may be more effective than azithromycin in shortening coughing. The early administration of antibiotics may also help prevent the spread of disease during the resurgence of pertussis and should be considered regardless of the laboratory confirmation, while taking into account the potential side effects of an unnecessary therapy.
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