Expert panel recommends new antibiotic strategies for resistant Bordetella pertussis

Pertussis, or whooping cough, remains a highly contagious respiratory infection caused by Bordetella pertussis. Despite inclusion of pertussis vaccines in immunization programs since the 1970s, outbreaks have re-emerged globally due to waning immunity and bacterial evolution. In China, cases have dramatically increased since 2017, with more than 400,000 reported between January and July 2024. Meanwhile, resistance to macrolide antibiotics, once the first-line treatment, has become widespread, leading to therapeutic failures. Because of these challenges, new clinical guidelines are needed to redefine diagnostic criteria, optimize antibiotic use, and improve treatment strategies for pediatric pertussis.

A new expert consensus (DOI: 10.1007/s12519-024-00848-5) was released on November 14, 2024, in World Journal of Pediatrics by researchers from leading children's hospitals and research centers across China, such as Children's Hospital, Zhejiang University School of Medicine, Beijing Children's Hospital and Chinese Center for Disease Control and Prevention. The consensus consolidates national data and multi-disciplinary expertise to propose a standardized framework for the diagnosis and treatment of pediatric pertussis. It provides updated recommendations on laboratory detection, antibiotic resistance, severe case management, and preventive measures, helping clinicians address the ongoing resurgence of this vaccine-preventable disease.

The consensus highlights the changing epidemiological pattern of pertussis, which now affects school-aged children and adults, turning them into major infection sources for infants. A significant concern is the emergence of erythromycin-resistant B. pertussis (ERBP), which accounts for nearly all isolates in China between 2013 and 2022. The authors propose detailed diagnostic procedures combining clinical symptoms, polymerase chain reaction (PCR) and serological testing, and case classification for severe and high-risk patients. For treatment, the panel recommends discontinuing macrolides as first-line therapy when resistance is detected or suspected. Instead, trimethoprim-sulfamethoxazole (TMP-SMX) is advised for children older than two months, while piperacillin or cefoperazone-sulbactam is recommended intravenously for infants under two months or severe cases. The guidelines also include therapeutic plasma exchange for patients with hyperleukocytosis, oxygen therapy for respiratory distress, and inhaled nitric oxide or extracorporeal membrane oxygenation (ECMO) for pulmonary hypertension. Preventive measures emphasize early etiological testing, isolation, and booster vaccinations to curb transmission.

Pertussis is no longer confined to infants—it's increasingly seen in older children and adolescents who spread the disease to vulnerable newborns. Our consensus aims to equip clinicians with a practical and evidence-based roadmap for diagnosis and management. By recognizing resistant strains and tailoring antibiotic strategies, we can significantly reduce severe outcomes and mortality among children."

Prof. Chun-Zhen Hua, one of the lead authors from Children's Hospital, Zhejiang University School of Medicine

The new expert consensus provides an essential reference for clinicians and public health professionals managing pertussis in children. It bridges laboratory detection, clinical evaluation, and evidence-based antibiotic selection, supporting early intervention and rational drug use in the face of rising resistance. The framework may also guide future research on pertussis pathogenesis, vaccine effectiveness, and antibiotic policy. In the long term, the recommendations are expected to strengthen national disease control systems, reduce the disease burden, and contribute to safer pediatric health practices in China and beyond.