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County of Orange, Health Care Agency, Epidemiology & Assessment
  Pertussis
Disease Prevention

Updated - April 27, 2006

Reporting is required for all cases, including suspect cases. Do not wait for laboratory results to report a clinically consistent case. Report to Epidemiology & Assessment: phone (714) 834-8180, fax (714) 834-8196 within one (1) working day.

Pertussis Treatment and Chemoprophylaxis Dosages*

Treatment of suspect and confirmed cases of pertussis within 21 days of cough onset can decrease transmission of the organism to others. Asymptomatic close contacts, including household contacts and others who have had face-to-face contact with a symptomatic suspect or confirmed case of pertussis, should receive prophylaxis for pertussis if within 21 days of cough onset in the index case. Any symptomatic (coughing) contacts should be treated as if they had pertussis and reported to Epidemiology (phone 714-834-8180 or fax 714-834-8196) for further contact tracing and recommendations.

Choice of antibiotics, dosing, and duration is the same for pertussis treatment and prophylaxis. Please refer to the table below, excerpted from the 2005 CDC Guidelines for Treatment and Postexposure Prophylaxis of Pertussis (MMWR Recommendations and Reports 2005;54(RR-14):1-16, available at: http://www.cdc.gov/mmwr/PDF/rr/rr5414.pdf).

Age Group

 Primary Agents Alternate Agent*

Azithromycin

Erythromycin

Clarithromycin

 TMP-SMZ
<1 month Recommended agent. 10 mg/kg per day in a single dose for 5 days (only limited safety data available.) Not preferred. Erythromycin is associated with infantile hypetrophic pyloric stenosis.  Use if azithromycin in unavailable, 40-50 mg/kg per day in 4 divided doses for 14 days Not recommended (safety data unavailable) Contraindicated for infants <2 months (risk for kernicterus)


1-5 months

 

 10 mg/kg per day in a single dose for 5 days 40-50 mg/kg per day in 4 divided doses for 14 days 15 mg/kg per day in 2 divided doses for 7 days

 

 Contraindicated at age <2 months. For infants aged >2 months, TMP 8 mg/ kg per day, SMZ 40 mg/kg per day in
2 divided doses for 14 days
Infants (aged >6 months) and children 10 mg/kg in a single dose on day 1 then 5 mg/kg per day
(maximum: 500 mg) on days 2–5 		40–50 mg/kg per day
(maximum: 2 g per day) in 4 divided doses for 14 days 		15 mg/kg per day in 2 divided doses (maximum: 1 g per
day) for 7 days 		TMP 8 mg/kg per day, SMZ 40 mg/kg per day in 2 divided
doses for 14 days
Adults 500 mg in a single dose on day 1 then 250 mg per day on days 2–5 2 g per day in 4 divided doses for 14 days 1 g per day in 2 divided doses for 7 days TMP 320 mg per day, SMZ 1,600 mg per day in 2 divided
doses for 14 days
* Trimethoprim sulfamethoxazole (TMP–SMZ) can be used as an alternative agent to macrolides in patients aged >2 months who are allergic to macrolides, who cannot tolerate macrolides, or who are infected with a rare macrolide-resistant strain of Bordetella pertussis.

 

NOTE:  RE:  Pregnant women and breastfeeding mothers:

  • Pregnant women and breastfeeding mothers should not take TMP/SMZ because of the potential risk of kernicterus in infants < 2 months of age.

  • Physicians caring for pregnant women should weigh the risks and benefits of treatment/prophylaxis with the macrolides, especially in households containing infants <12 months of age or expecting a new baby, as young infants are at the highest risk for serious complications from pertussis.  Azithromycin and erythromycin are classified as Pregnancy Category B drugs and clarithromycin is Pregnancy Category C.

Vaccination of Contacts following Pertussis Exposure:

If a child less than 7 years old is unimmunized or has not received 4 doses of pertussis-containing vaccine (DTaP or DTP), initiate or continue vaccination according to the recommended schedule (available at http://www.cdc.gov/nip/recs/child-schedule.htm#Printable).

  • If at least 6 months have elapsed since the 3rd dose and the child is at least 12 months of age, give the 4th dose immediately.
  • If the child has received 4 doses of DTaP, give a 5th dose unless the last dose was within the last 3 years. A 5th dose is not necessary if the 4th dose in the series is administered on or after the fourth birthday.

Children 11 – 18 years of age should be given one booster dose of Tdap (Boostrix or Adacel) if they have completed their primary childhood immunization series, have not received Tdap before, AND it has been at least 2 years since their last Td. For more information about the use of Tdap in adolescents, see the CDC ACIP Recommendations (http://www.cdc.gov/mmwr/PDF/rr/rr5503.pdf).

Adults should be given one dose of Tdap (Adacel is the only product currently licensed for adults) if they have not received Tdap before AND it has been at least 2 years since their last Td. If an adult has not received the primary tetanus and diphtheria series, Tdap can still be given and then the series completed with Td. For more information about the use of Tdap in adults, see the ACIP Provisional Recommendations (http://www.cdc.gov/nip/recs/provisional_recs/).

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