Good management of whooping cough includes:
- Recognition of complications and early referral for supportive care
- Early antibiotic treatment to reduce transmission
- Educating and informing your patient about whooping cough
- Preventing transmission by keeping infectious patients home from childcare, school or work
- Managing contacts of infectious patients in collaboration with your public health unit.
- The youngest infants are at greatest risk of complications and sudden death - early diagnosis and treatment are important. Infants should be monitored frequently and referred early if apnoeas are occurring as intubation and ventilation may be required.
- Infants under six months of age commonly require hospitalisation in order to monitor the severity of respiratory compromise, to prevent and treat complications.
All neonates with whooping cough should be urgently referred for specialist assessment. Whooping cough deaths are almost always in babies under two months of age.
- Antibiotics reduce the period of communicability and should be initiated as soon as possible and within three weeks of the onset of the cough.
- Patients are no longer infectious after five days of appropriate antibiotic therapy.
- Antibiotics probably don't reduce cough duration in most patients.
Table 1: Current recommendations for treatment of infectious cases (first three weeks of symptoms)
||500 mg orally on day 1 then 250 mg orally daily for a further 4 days.
Less than 6 months: 10 mg/kg orally, daily for 5 days.
Older than 6 months: 10 mg/kg up to 500 mg orally on day 1 then 5 mg/kg up to 250 mg daily for a further 4 days.
||500 mg orally 12-hourly for 7 days.
||7.5 mg/kg up to 500 mg 12-hourly for 7 days. |
|Trimethoprim + Sulfamethoxazole
||160+800 mg orally 12-hourly for 7 days.
||Older than 2 months: 4+20 mg/kg up to 160+800 mg 12-hourly for 7 days. |
- Early antibiotics reduce infectious period to five days but are unlikely to alter the duration of cough.
- There is currently insufficient clinical evidence to recommend the use of roxithromycin for the management of pertussis.
- Resistance of Bordetella pertussis to macrolides has been reported rarely.
- Penicillins and cephalosporins are not effective against Bordetella pertussis.
- Respiratory co-infections may occur and may require modification of antibiotic therapy. Sputum culture results should be used to guide antibiotic choice.
Source: Therapeutic Guidelines: Antibiotic (version 15, 2014)
Three key things you should tell your patients with whooping cough:
- How long they are infectious (after five days of antibiotic treatment or three weeks from onset if untreated)
- How the infection is transmitted (mainly by coughing near somebody else)
- Stay away from infants and pregnant women
A whooping cough factsheet can reinforce the main public health messages for your patients.
Keep infectious patients home
If your patient is infectious, explain that it's important to not attend work, school, preschool, and childcare until after 5 days of effective antibiotic treatment. Provide a medical certificate as appropriate. It's especially important for cases not to be around infants or women in the late stages of pregnancy if they are infectious.
If your patient has had a cough for more than three weeks, they should not be infectious and no longer require antibiotic treatment or exclusion, even though they may still be coughing.