Back | Print
Treatment and prevention of Bordetella pertussis infection in adolescents and adults
Authors Elizabeth McNeill Byrd, MD Christopher A Ohl, MD Section Editor Stephen B Calderwood, MD Deputy Editor Elinor L Baron, MD, DTMH
Last literature review version 18.2: 18, 2010 (More)
May 2010 | This topic last updated: JuneINTRODUCTION — Pertussis, or "whooping cough", is an acute, communicable infection of the respiratory tract caused by the gram-negative bacterium, Bordetella pertussis. Other species of Bordetella occasionally cause human illness: B. parapertussis causes a mild pertussis-like illness, and B. bronchosepticum, usually an animal pathogen, can cause respiratory infections, especially in immunocompromisedhumans [ 1]. While pertussis has generally been considered an infection of children associated with considerable morbidity and mortality, it is increasingly recognized in adults. The index of suspicion for pertussis must be high in order to make a prompt diagnosis. Early treatment may lessen the severity of the clinical course and prevent infections in contacts and in the community. However,recognition of pertussis in adolescents and adults can be difficult since symptoms are frequently atypical, especially in those who have been previously vaccinated. The treatment and prevention of pertussis will be reviewed here. The pathogenesis, epidemiology, clinical manifestations, and diagnosis of this infection are discussed separately. (See "Pathogenesis and epidemiology of Bordetella pertussisinfection" "Clinical features and diagnosis of Bordetella pertussis infection in adolescents and adults".)
TREATMENT — Antimicrobial therapy for pertussis may ameliorate symptoms and can decrease transmission to susceptible contacts when administered early in the course [2-5]. Obtaining laboratory confirmation of pertussis may be difficult and take several days to weeks, depending on theavailable laboratory facilities and methods used. Consequently, antimicrobial therapy should be initiated when there is significant clinical suspicion that a patient's symptoms may be due to pertussis. Adolescents or adults can be managed as outpatients in almost all cases. (See "Clinical features and diagnosis of Bordetella pertussis infection in adolescents and adults", section on 'Laboratorydiagnosis' .)
Antibiotics should be used for patients with ≤3 to 4 weeks of symptoms [ 6]. The utility of antimicrobial therapy is less clear for individuals with cough persisting >4 weeks, though should be considered. A comprehensive review of antimicrobial agents for the treatment of pertussis is available from the Centers for Disease Control and Prevention [ 2]. Adjuvant therapy withpertussis immune globulin is currently under investigation [ 2,7]. It has been suggested as a means to reduce the severity and mortality of pertussis, particularly in infants and young children. Its use is not recommended currently, pending the results of a controlled trial. Rationale — Antimicrobial treatment is recommended for all recently infected individuals, regardless of their age [ 2,8,9]. • Earlytreatment (eg, during the first seven to fourteen days of symptoms) may decrease the severity of symptoms [ 2,4,10-12]. Whether treatment initiated later, during the paroxysmal stage, will alter the clinical course of whooping cough is uncertain; two studies evaluating erythromycin treatment yielded conflicting results [13,14]. Unfortunately, most patients do not come to medical attention untilthe paroxysmal phase. (See "Clinical features and diagnosis of Bordetella pertussis infection in adolescents and adults", section on 'Clinical features' .) • Patients are most contagious during the catarrhal stage and during the first two weeks after onset of coughing. Treatment of the index case in this time frame limits the spread of infection to household contacts in both children and adults [...