Whooping Cough / Pertussis - Treatment & Prevention

Treatment & Prevention

Whooping cough patients are treated with antibiotics and supportive care. DPT vaccine is used to prevent infection.


Treatment:

The treatment of whooping cough aims at the eradication of B.pertussis from the respiratory tract. The treatment modalities are

Antibiotics: Erythromycin, an antibiotic is given for a period of 14 days to treat the infection and prevent relapse. Other antibiotics which can be used include azithromycin, clarithromycin or trimethoprim/sulfamethoxazole (TMP/SMX). Some bacteria may be resistant to certain antibiotics. Besides treating the affected individual, all the contacts or people in the household should be advised antibiotics to prevent infection.

Supportive care: Whooping cough cases need hospitalization and isolation to prevent further spread. The patient should be closely monitored for the development of apnea (cessation of breathing), cyanosis (bluish discoloration of the skin and mucous membranes due to inadequate oxygenation of the blood) and other complications. Nutritional support, hydration and oxygen supplementation should be provided.

Prevention:

Management of people coming in close contact with the patient: All contacts with the patient irrespective of their ages and immunization status need to be protected with erythromycin. Erythromycin is very effective if given within 2 weeks of the development of symptoms. All children less than 7 years need to be immunized.

Vaccines: Diphtheria pertussis tetanus vaccine (DPT) is currently being used in the primary immunization of infants. It is a vaccine which primarily consists of killed whole cells B.pertussis organisms which is combined with diphtheria and tetanus toxoids in an adjuvant. The recommended or standard immunization schedule consists of three primary doses at 2 months interval with the first dose given at 6-8 weeks of age. Booster doses are then given at 15-18 months and 4-6 years of age. There is a high rate of adverse reaction in adolescents and adults with whole cell vaccine and the routine immunization of people in this age group is not recommended. However, epidemic outbreaks may require vaccination above 6 years of age as well. The duration of protection is usually 5-10 years. The vaccine may result in adverse effects in infants such as localized pain, seizures, persistent crying and the development of fever. In rare cases, the risk of acute encephalopathy (degenerative disease of the brain) is higher during the 7 days after DTP immunization. DtaP and aP are newer acellular vaccines which have considerably reduced the side effects associated with the whole-cell pertussis vaccine.

References

1. Johnston, Richard B. "Whooping Cough (Pertussis)." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 1829�30.
2. Impact of Nasopharyngeal Swab Types on Detection of Bordetella pertussis by PCR and Culture. Joann L. Cloud, Weston Hymas, and Karen C. Carroll. J Clin Microbiol. 2002 October; 40(10): 3838�3840.10.1128/JCM.40.10.3838-3840.2002.
3. Long, Sarah S. "Pertussis (Bordetella pertussis and B. parapertussis)." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 908�11.
4. Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults. Pichichero ME, Rennels MB, Edwards KM, et al. (June 2005). JAMA 293 (24): 3003�11. doi:10.1001/jama.293.24.3003. PMID 15933223.
5. Acute Respiratory Infections in Children. Simoes EAF, Cherian T, Chow J, Shahid-Salles SA, Laxminarayan R, John TJ. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank; 2006. Chapter 25. PMID: 21250360 [PubMed]
6. Acellular vaccines for preventing whooping cough in children.Zhang L, Prietsch SO, Axelsson I, Halperin SA. Cochrane Database Syst Rev. 2011 Jan 19;1:CD001478.PMID: 21249646 [PubMed - in process]

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