Lthe High Authority for Health (HAS) has put online, in the form of a memo sheet for the attention of prescribers [1, 2]recommendations relating to antibiotic therapy to manage suspected or confirmed pertussis, or contact cases of confirmed pertussis.
These recommendations are proposed in a context of a sharp increase in cases of whooping cough in France and Europe (cf. our article of June 11, 2024). They were developed in partnership with the French-language Society of Infectious Pathology (SPILF) and the Pediatric Infectious Pathology Group (GPIP) and reviewed by the College of General Medicine and the relevant learned societies.
In 4 pages, the memo sheet dedicated to the antibiotic treatment of whooping cough summarizes the following elements:
- the definition of whooping cough: bacterial infection, mainly associated with the agent Bordetella pertussis ;
- diagnosis: biological diagnosis (PCR, culture on specific media) from a deep nasopharyngeal sample (cf. our article of June 11, 2024);
- what to do in the event of suspected or confirmed (documented) whooping cough;
- antibiotic treatment:
- in pediatric population,
- in adult population;
- antibiotic prophylaxis of contact cases in case of confirmed whooping cough;
- the eviction of suspected cases in schools;
- prevention of whooping cough: compulsory vaccination for children born since 2018, vaccination of pregnant women during each pregnancy (cf. our article of June 11, 2024).
Antibiotic therapy for whooping cough: macrolides as first intention
In case of suspected or confirmed (documented) pertussis, antibiotic treatment is recommended « to reduce carriage and contagiousness but it has no effect on the progression of the disease, especially since the diagnosis is late »specifies the HAS.
Antibiotic treatment should be administered as soon as possible and within the first 3 weeks of development and in oral suspension in children under 6 years of age.
It must be associated with barrier gestures:
- avoid contact with infants, especially under 6 months;
- hand washing and wearing a mask.
First-line clarithromycin
Antibiotic therapy to treat whooping cough is mainly based on macrolides. Clarithromycin is the first-line treatment in children and adults (ZECLAR range and generics):
- Infant
- Infants ≥ 3 months and children: at the dosage of “1 weight dose” twice a day for 7 days (i.e. 15 mg/kg/day), without exceeding the adult dosage of 500 mg twice a day;
- Adult: 500 mg 2 times a day for 7 days.
Azithromycin second line
Azithromycin is one of the antibiotics « critiques » with a strong ecological impact, it is only recommended as second-line treatment (ZITHROMAX range and generics, ORDIPHA):
- Infant
- Infants ≥ 3 months and children: at the dosage of “1 weight dose” once a day for 3 days (i.e. 20 mg/kg/day), without exceeding the adult dosage of 500 mg once a day;
- Adult: 500 mg per day for 3 days.
In case of contraindication to macrolides or out of stock
In case of contraindication to macrolides, the cotrimoxazole (sulfamethoxazole-trimethoprim – BACTRIM and COTRIMOXAZOLE TEVA range) can be considered as an alternative:
- in infants ≥ 3 months and children: 6 mg/kg/day in 2 doses per day (dose expressed as trimethoprim) for 7 days, without exceeding the adult dosage of 800/160 mg 2 times per day. Cotrimoxazole should not be used in infants younger than 6 weeks;
- in adults: 1 tablet of 800/160 mg twice a day for 7 days.
In case of stock shortage, erythromycin (which also belongs to the macrolide class) can be considered:
- in children from 25 kg: 40 mg/kg/day in 2 to 3 doses per day for 14 days without exceeding the adult dosage of 1 g 3 times per day (dosage forms suitable for infants and children under 25 kg are no longer sold);
- in adults (ERY 500 mg tablet): 1 g 2 times a day for 14 days.
Antibiotic prophylaxis of contact cases in confirmed pertussis: target and treatment
Antibiotic prophylaxis is indicated in cases of close contacts with the index case (confirmed) during the contagious period in:
- unvaccinated or poorly vaccinated children:
- 11 months or less having received less than 2 doses of pertussis vaccine,
- over 11 months having received less than 3 doses of pertussis vaccine;
- children and adults whose last vaccination against whooping cough was more than 5 years ago: these people are considered not protected against whooping cough.
Antibiotic prophylaxis is also indicated in cases of casual contacts among people unprotected against whooping cough and at risk of severe form :
- infants under 1 year old;
- fragile subjects such as:
- immunocompromised people,
- those suffering from chronic respiratory pathologies (asthma, COPD),
- pregnant women.
Antibiotic prophylactic treatment is even than curative treatment.
It must begin as soon as possible and maximum 21 days after the last contact with the index case.
