A 2005 Cochrane review of 11 RCTs and 1 quasi-randomized trial, with a total of 1720 adults and children, investigated several antibiotics for treatment and prophylaxis of pertussis. The outcome measures used to assess the efficacy of antibiotic treatment or prophylaxis vary between the trials and most of them did not report the immunization status of the participants. The Cochrane review included 1 meta-analysis of 3 studies with 252 participants, comparing azithromycin for 3 days, erythromycin estolate for 7 days, and clarithromycin for 7 days (short-term treatment) with erythromycin estolate for fourteen days (long-term treatment). The study showed equal efficacy in eradication of B pertussis from the nasopharynx of 99.2% to 97.7% (absolute risk reduction [ARR]=1.44%; 95% confidence interval [CI], -1.58 to 4.46). There were fewer side effects with the short-term treatment (32.1% vs 48.9%; ARR=16%; 95% CI, 7.84 to 25.84). A large, multicenter RCT of 477 children of 6 months to 16 years of age demonstrated that a 5-day treatment with azithromycin eradicated B pertussis from the nasopharynx as effectively as a 10-day course of erythromycin estolate. Similarly, trimethoprim/sulfamethoxazole proved as effective as erythromycin in eliminating B pertussis from the nasopharynx. Although tetracycline and chloramphenicol are effective treatments for pertussis, they are not recommended because of their side effects. Six randomized trials failed to show any statistically significant difference between antibiotics and placebo on frequency and severity of cough or duration of pertussis disease. A randomized, placebo-controlled trial studied 300 household contacts of children with culture-positive pertussis. There was no statistically significant difference in either the frequency of pertussis disease or rate of positive cultures in household contacts between the erythromycin group (2.1%) and the placebo group (5.1%) (ARR=2.95%; 95% CI, -1.21 to 7.11). Another Cochrane review of 8 trials examined the effectiveness of the symptomatic treatment of cough in children and adults with pertussis. There were many problems with the methodological quality of these trials, including small sample sizes and poor reporting of the methods. Diphenhydramine, pertussis immunoglobulin, corticosteroids and salbutamol were compared with placebo. There were no statistically significant differences in coughing paroxysms, mean number of whoops per 24 hours or in duration of hospital stay between these interventions and placebo. Extracorporeal circulatory life support has been used to maintain perfusion for patients with severe disease. The mortality of these patients is very high. No RCTs of the effectiveness of this intervention has been performed.
|Original language||English (US)|
|Number of pages||3|
|Journal||Journal of Family Practice|
|State||Published - Dec 2005|
ASJC Scopus subject areas
- Family Practice