Therapeutic targets
- Elimination of the pathogens
- Alleviation of discomfort
- Avoidance of complications
Therapy recommendations
- Symptomatic therapy (antitussive/antitussive for nighttime rest, if necessary), i.e., treatment of symptoms.
- Sensible antibiotic therapy starts early (i.e., in the stage catarrhale/initial stage with cold-like cough; at the latest by 3 weeks after the onset of the stage convulsivum/seizure-like cough). Only by this time are the pathogens eliminated. First-line agents are azithromycin and clarithromycin (macrolides).
- Caveat. The U.S. Food and Drug Administration advises caution in prescribing the antibiotic clarithromycin in patients with preexisting cardiac conditions. Results of a 10-year follow-up after 2-week treatment with clarithromycin showed increased all-cause mortality (hazard ratio 1.10; 1.00-1.21), and the rate of cerebrovascular disease (hazard ratio 1.19; 1.02-1.38) was also increased.
- Antibiotic therapy has a disease-shortening effect.
- Later antibiotic therapy (up to 4 weeks after the onset of cough) may also be useful (see above) to prevent further transmission (pregnant women: 6 weeks). Note: Antibiotic therapy eliminates the pathogen from the nasopharynx (= interruption of the chain of infection), but has little effect on the cough.
- In the presence of risk factors therapy duration 7 to 10 days.
- Antibiotic prophylaxis is recommended for the contact person living in a household with a child under the age of six months.
- Postexposure prophylaxis (PEP) [see below].
- See also under “Further therapy”.
Postexposure prophylaxis (PEP)
Post-exposure prophylaxis is the provision of medication to prevent disease in individuals who are not protected against a particular disease by vaccination but have been exposed to it.
Indications (areas of application)
- Persons without vaccination protection with close contacts to a diseased person, especially in the family or in residential communities and communal facilities.
Implementation
- Chemoprophylaxis with a macrolide (azithromycin or clarithromycin/antibiotic).
