Cochrane Review: Antibiotics for whooping cough (pertussis)

Abstract

BackgroundWhooping cough is a highly contagious respiratory disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis but its benefit is uncertain.ObjectivesTo assess the risks and benefits of antibiotic treatment of and contact prophylaxis against whooping cough in children and adults.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 4, 2010), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, the Database of Abstracts of Reviews of Effects (DARE Issue 4, 2010), MEDLINE (1966 to January Week 1, 2011) and EMBASE (1974 to 18 January 2011).Selection criteriaRandomised controlled trials (RCTs) and quasi‐RCTs of antibiotics for treatment of and contact prophylaxis against whooping cough in children and adults.Data collection and analysisThree to four review authors independently extracted data and assessed the quality of each trial.Main resultsThirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; two investigated prophylaxis regimens. The quality of the trials was variable. For eradicating Bordetella pertussis (B. pertussis) from the nasopharynx, short‐term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long‐term (erythromycin for 10 to 14 days) (risk ratio (RR) 1.01; 95% confidence interval (CI) 0.98 to 1.04), but had fewer side effects (RR 0.66; 95% CI 0.52 to 0.83). Trimethoprim/sulphamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long‐term antibiotics. For preventing infection by treating contacts older than six months of age, antibiotics did not significantly improve clinical symptoms, nor the number of cases developing culture‐positive B. pertussis. Side effects were reported with antibiotics and they varied from one antibiotic to another.Authors' conclusionsAlthough antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefits of prophylactic treatment of pertussis contacts.Plain Language SummaryAntibiotics for whooping cough (pertussis)Whooping cough is a highly contagious disease caused by pertussis bacteria and may lead to death, particularly in infants less than 12 months of age. Although it can be prevented by routine vaccination, it still affects many people. Thirteen trials involving 2197 participants were included in this review. We found that several antibiotic treatments were equally effective in eliminating the bacteria infecting patients, but they did not alter the clinical outcome. There was insufficient evidence to decide whether there is benefit for treating healthy contacts. Side effects were reported with antibiotics and they varied from one antibiotic to another. The result of the review should be interpreted with caution since this review is based on a limited number of trials and some of these trials involved small numbers of participants.

Pertussis (whooping cough)

“…Beyond the first 21 days of illness, or two days of antibiotic treatment, patients are no longer infectious 265758. Azithromycin taken for 3-5 days, or clarithromycin or erythromycin taken for seven days are as effective as previously recommended longer regimen lasting 14 days, and have fewer side effects, suggests a Cochrane systematic review (11 randomised controlled trials) 59. Be aware of potential drug interactions of macrolides in patients taking medications such as theophylline or warfarin 58.…”

Public health measures for pertussis prevention and control

“…Antibiotics have been shown to reduce the duration of symptoms as well as decreasing the transmission risk if administered within the first three weeks of the cough onset. 11 The preferred antibiotics are macrolides, particularly the newer derivatives such as azithromycin, which are associated with greater treatment adherence than erythromycin due the superior tolerability and reduced frequency of dosing. 12,13 Azithromycin was also shown in a large, multicentre, randomised trial to be as effective as erythromycin for the treatment of pertussis in children, which led to the preferential recommendation towards azithromycin in most settings.…”

Pertussis – eine impfpräventable Erkrankung

“…Besteht eine Unverträglichkeit gegenüber Makroliden, so wird als Alternative Trimethoprim-Sulfamethoxazol erwähnt [1].…”