Effect of Macrolides and β-lactams on Clearance of Bordetella pertussis in the Nasopharynx in Children With Whooping Cough

Abstract

Objective: The purpose of the current study is to investigate the bactericidal effect of macrolides and β-lactams on Bordetella pertussis (B. pertussis) in the nasopharynx and provide guidance for treating macrolides-resistant B. pertussis infections. Methods: Patients with whooping cough was diagnosed by culture of nasopharynx swabs between January 2016 to December 2018. B. pertussis was identified using specific antisera against pertussis and parapertussis. Drug susceptibility test was carried out using the E-test method. The clearance of B. pertussis in nasopharynx at 7 and 14 days into and posttreatment with macrolides, and β-lactams was compared. Results: A total of 125 B. pertussis samples were collected from patients who received single antibiotic treatment. Among those isolates, 62.4% (78/125) had high resistance with minimum inhibitory concentrations greater than 256 mg/L for erythromycin and azithromycin. The MIC90 of piperacillin, cefoperazone-sulbactam, meropenem, ampicillin, ceftriaxone, ceftazidime and trimethoprim-sulfamethoxazole for these isolates was <0.016, 0.094, 0.094, 0.19, 0.19, 0.25 and 0.75 mg/L, respectively. The clearance rate with β-lactams treatment (68.8%, 44/64) was significantly higher than that with macrolides treatment at 14 days posttreatment (50.8%, 31/61) (χ2 = 4.18, P = 0.04). Macrolides had a better clearance rate at 7 days posttreatment than β-lactams (χ2 = 4.49, P = 0.03) for macrolides-sensitive isolates and a worse clearance rate for macrolides-resistant isolates. Conclusion: B. pertussis isolates had a high-resistant rate for macrolides in our study. Macrolides are the first choice for treating pertussis caused by macrolides-sensitive strains, and some β-lactams such as piperacillin should be considered as alternative antibiotics for treatment of macrolides-resistant B. pertussis infection.

A Cross-Sectional Study Revealing the Emergence of Erythromycin-Resistant Bordetella pertussis Carrying ptxP3 Alleles in China

“…The overuse of macrolides in China is a key factor determining the prevalence of China-specific ptxP1 -ER isolates ( Yao et al, 2020 ). The high rate of antibiotic administration and predominance of ER strains in positive cultures are suggestive of the failure of erythromycin treatment in China, as recently demonstrated in clinical research by Mi et al (2021) . The present cases of pertussis caused by ptxP1 strains seemed more severe than those caused by ptxP3 strains.…”

“…Ampicillin has been shown to strongly inhibit B. pertussis in vitro , but its clinical efficacy is debated ( Li et al, 2019 ; Cimolai, 2021b ). Mi et al (2021) recently reported that β-lactam antibiotic treatment is more effective for the clearance of ER B. pertussis than macrolide treatment. The tested isolates were commonly sensitive to levofloxacin and gentamycin.…”

The effect of low-molecular-weight heparin combined with amikacin on the coagulation function and bacterial clearance in the treatment of patients with severe senile pneumonia

“…Detection method: 3ml of peripheral venous blood was collected into a vacuum tube containing 0.09% sodium citrate anticoagulant, centrifuged at 3000r/ minute for 10 minutes, and the levels of coagulation function indexes in the supernatant were measured within 60 minutes using relevant kits according to manufacturer's instructions and full-automatic hemagglutination analyzer (STAGO compact type in France) for detection. Bacterial clearance effect: 10 sputum samples after treatment were inoculated and cultured; suspicious bacteria after culture were selected and stained with Gram staining. Pathogenic bacteria were detected by microbial identification and drug sensitivity analysis.…”

Macrolide Resistance in Bordetella pertussis: Current Situation and Future Challenges

“…The emergence of macrolide resistance has raised new questions regarding the optimal treatment of young infants with infection caused by macrolide-resistant B. pertussis . In vitro, several classes of antibiotics seem to be effective against B. pertussis , including SMZ-TMP, levofloxacin, ampicillin, 3rd-generation cephalosporins, gentamicin and piperacillin-tazobactam [ 17 , 34 , 38 , 40 , 46 , 63 ]. However, no data regarding clinical benefit of these antibiotics in infants with severe pertussis caused by a macrolide-resistant strain exist.…”

“…In two novel studies, piperacillin and cefoperazone-sulbactam were shown to be effective for killing B. pertussis both in vitro and in vivo, providing good options for alternative treatment in hospitalized infants if an isolate is identified to be macrolide resistant, although their suitability for young infants still needs to be better studied [ 34 , 35 ]. As stated in the study by Hua et al [ 33 ], a controlled clinical trial including more pertussis patients to be treated with single piperacillin, cefoperazone or other antibiotics is scheduled in Zhejiang, China.…”