Current pharmacotherapy of pertussis

Human infection with Bordetella pertussis and Bordetella parapertussis causes significant morbidity and mortality. While universal immunisation represents the mainstay of prevention, the purpose of this review is to summarise the current options for antimicrobial chemotherapy of pertussis. Several chemotherapeutic approaches have an important place in therapy and in infection control. Supportive treatment including nasopharyngeal suction, oxygen and parenteral fluids, is essential for infants < 1 year who are at greatest risk of complications and permanent sequelae. Steroids and beta2-agonists are also used in the management of severe neonatal pertussis. Several antibiotics have been shown to reduce the level of bacterial colonisation of the respiratory tract, however, erythromycin is accepted to be the treatment of choice. Erythromycin reduces severity and duration of disease, even if started during the paroxysmal phase. A 14 day course is recommended although side effects may limit compliance; a recent study indicates that a 7 day course may have similar efficacy in terms of eradication and prevention of relapse. Alternatives to erythromycin are clarithromycin, azithromycin and trimethoprim-sulfamethoxazole. Fluoroquinolones have good in vitro activity against both B. pertussis and B. parapertussis and may be useful in the treatment of adult patients with pertussis, although there are no supporting clinical data at present. Erythromycin prophylaxis is also recommended for close household contacts of patients with pertussis.