By Dr Ananya Mandal, MD
Whooping cough or Pertussis is an infectious disease caused by bacteria Bordetella pertussis.
Mild cases can be managed at home with adequate rest and fluids and antibiotics. Severe cases however may need hospital admission.
There are a few possible treatments for whooping cough including antibiotics, supportive therapy and so forth. (1, 2, 3, 4, 5, 6)
The role of antibiotics is debatable. However, since diagnosis often is difficult in the initial stages, antibiotics may be needed. These antibiotics remove the bacteria from the airway but need to be started in the Catarrhal phase or the initial phase of mild disease.
The preferred antibiotic is Erythromycin for 14 days (children: 40 to 50 mg/kg per day in four divided doses; adults: 1 to 2 g/day). A course for 7 days may also be effective in milder cases.
Other agents of the same antibiotic class that can be used include Azithromycin, 10 mg/kg on the first day followed by a daily dose of 5 mg/kg on days 2 through 5.
Clarithromycin is another alternative.
If the infection is resistant to treatment with any of these, other antibiotics like trimethoprim–sulfamethoxazole (8 and 40 mg/kg per day) may be tried.
In addition to the patient, close contacts of an infected case need to take antibiotics to prevent infection.
The US Centers for Disease Control and Prevention (CDC) recommends erythromycin as the drug of choice in these cases except in infants 2 weeks of age or younger. Azithromycin and Clarithromycin are alternatives.
Supportive therapy for severe cases
This includes use of oxygenation and intravenous fluids on hospitalization.
Antibiotics for other infections that complicate whooping cough may also be needed.
Sometimes corticosteroids may be needed. These are hormonal preparations that reduce inflammation and swelling of the airways affected with the disease making breathing easier. These may also be given intravenously.
Cough medications for mild illness may not be of much use.
A cool mist vaporizer can be used to loosen the secretions.
Supportive home care
Supportive home care includes drinking plenty of fluids, soups, juices etc. to prevent dehydration and taking small and frequent meals to prevent vomiting.
The home should be freed of irritants that can lead to coughing. This includes smoke, chemical fumes, dust etc.
Preventing the spread of whooping cough
Prevention of spread is vital. This includes keeping the infected child isolated, repeated hand washing and covering of the mouth and nose while coughing or sneezing.
Whooping cough can be prevented by widespread vaccination of children and adults who are at risk.
Use of acellular vaccine in children has drastically reduced the incidence of cases of the disease.
The US CDC recommends pertussis vaccine for children that is called the DTaP. It can protect against diphtheria, tetanus, and pertussis.
The shots are administered at 2, 4, and 6 months of age. The fourth comes between 15 to 18 months of age and the fifth shot is given before the child starts school at the age of 4 to 6 years.
The shot (Tdap) can be given at 11 to 12 years of age if the child has not received all his or her previous shots.
Pregnant women who have not received their vaccinations should get one dose of Tdap during the third trimester or late second trimester or just after they deliver before leaving the birthing care center or hospital.
If the vaccine is given during pregnancy, the newborn gets the protective antibodies from the mother at birth and protects the baby till his or her first vaccine dose.
Adults who are at risk of exposure to the infection, who have not been vaccinated as a teenager and those over 65 with a weakened immunity need to be given the vaccine. (5)
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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Last Updated: Jun 6, 2012