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Pertussis: Treatment and Care

Pertussis: Treatment and Care

The management of pertussis is multifaceted, involving antimicrobial therapy to eradicate the organism and supportive care to manage the severe symptoms. The goals of treatment differ depending on the stage of the illness; early antibiotic treatment can attenuate the course of the disease, while later treatment serves primarily to prevent transmission.

For infants, care often requires hospitalization and intensive monitoring due to the risk of respiratory failure. At Liv Hospital, the approach to care is holistic, ensuring that nutritional and respiratory needs are met while the body heals from the toxin-mediated damage.

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Macrolide Antibiotic Therapy

Macrolide antibiotics are the cornerstone of pharmacological treatment for pertussis. They work by inhibiting bacterial protein synthesis.

  • Azithromycin: This is the preferred agent for infants, including those under 1 month of age, due to its ease of dosing (once daily for 5 days) and lower risk of side effects compared to erythromycin.
  • Clarithromycin: Used as an alternative, typically a 7-day course. It is generally well-tolerated but requires twice-daily dosing.
  • Erythromycin: The historical standard, requiring a 14-day course with four doses a day. It is less favored now due to gastrointestinal side effects and a link to pyloric stenosis in newborns.
  • Trimethoprim-Sulfamethoxazole: This is an alternative for patients who cannot tolerate macrolides or who have macrolide-resistant strains.
  • Goals: If given during the catarrhal stage, antibiotics can reduce symptom severity. If given later, they eliminate the bacteria from the nasopharynx, rendering the patient non-infectious, but do not stop the cough immediately.
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Supportive Respiratory Care

Supportive Respiratory Care

The primary challenge in caring for a patient with pertussis is managing the paroxysmal cough and ensuring adequate oxygenation.

  • Oxygen Therapy: Supplemental oxygen is administered during coughing paroxysms if oxygen saturation drops.
  • Suctioning: In infants, thick mucus can obstruct the airway. Gentle suctioning is crucial to keep the nasopharynx clear, especially before feeds.
  • Monitoring: Continuous pulse oximetry and cardiac monitoring are essential for detecting apnea and bradycardia early in infants.
  • Intubation: In severe cases with respiratory exhaustion or uncontrollable apnea, mechanical ventilation may be required.
  • Humidification: Using a cool-mist humidifier can help soothe inflamed airways and loosen secretions.

Nutritional and Fluid Management

The paroxysmal coughing and post-tussive vomiting can lead to significant dehydration and malnutrition, particularly in infants.

  • Small, Frequent Feeds: Large meals can trigger vomiting. Feeding small amounts frequently is often better tolerated.
  • Intravenous Fluids: If oral intake is insufficient due to vomiting or respiratory distress, IV fluids are administered to maintain hydration and electrolyte balance.
  • Nasogastric Feeding: For infants who are too exhausted to suck but do not require intubation, a nasogastric tube may be placed to provide nutrition.
  • Feeding During Calm Periods: Caregivers are trained to time feedings during the intervals between coughing fits to minimize the risk of aspiration.
  • Weight Monitoring: Daily weight checks ensure that the infant is not losing excessive mass during the illness.

Management of Severe Complications

Management of Severe Complications

Severe pertussis, particularly in young infants, can lead to life-threatening complications that require advanced interventions.

  • Leukopheresis: In cases of extreme leukocytosis (very high white blood cell count), the thick blood can strain the heart and lungs. Exchange transfusion or leukapheresis may be used to remove excess white blood cells physically.
  • Pulmonary Hypertension: Severe pertussis can cause high blood pressure in the lungs. Inhaled nitric oxide or ECMO (Extracorporeal Membrane Oxygenation) may be used as rescue therapies.
  • Seizure Management: Anticonvulsant medications are used if seizures occur due to hypoxia or encephalopathy.
  • Pneumonia Treatment: If secondary bacterial pneumonia develops, additional antibiotics targeting the specific lung pathogens are added to the regimen.
  • Hernia Repair: A surgical consultation may be needed later for hernias caused by the intense abdominal pressure from coughing.

Isolation and Infection Control

Preventing the spread of the disease within the healthcare facility and the home is a critical part of care.

  • Droplet Precautions: Patients hospitalized with pertussis are placed in private rooms. Staff wear masks when entering the room.
  • Duration: Isolation is maintained for 5 days after the start of effective antibiotic therapy. If untreated, isolation should continue for 21 days.
  • Masking: Patients should wear masks when being transported within the hospital.
  • Hand Hygiene: Rigorous handwashing is required for all visitors and staff to prevent transmission via contaminated surfaces.
  • Limiting Visitors: Protecting the patient from secondary viral infections brought in by visitors is crucial during the recovery phase.

Post-Exposure Prophylaxis

Treatment extends to the infected individual’s close contacts to prevent secondary cases.

  • Definition of Contact: This includes household members, daycare contacts, and anyone with direct face-to-face exposure.
  • Antibiotic Regimen: The same antibiotics used for treatment (Azithromycin, etc.) are given to contacts as prophylaxis.
  • Universal Prophylaxis: Prophylaxis is recommended for all household contacts regardless of their vaccination status, as vaccine immunity may not prevent colonization or mild disease.
  • High-Risk Focus: Priority is given to contacts who are infants, pregnant women, or individuals with immunodeficiency.

Symptom Monitoring: Contacts are educated to monitor for signs of respiratory illness for 21 days.

Home Care and Education

For patients who are stable enough to be managed at home, caregiver education is vital.

  • Cough Management: Parents are taught that cough suppressants are generally ineffective and not recommended. The focus is on comfort and hydration.
  • Environment: Keeping the home free of irritants like smoke, dust, and strong odors can reduce the frequency of coughing fits.
  • Rest: Encouraging rest helps conserve energy for the demanding coughing episodes.
  • Red Flags: Parents are instructed to seek immediate medical attention if the child turns blue, stops breathing, or appears dehydrated.
  • Recovery Expectations: Managing expectations is essential; knowing that a cough can last for months (“100-day cough”) reduces anxiety about a slow recovery.

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FREQUENTLY ASKED QUESTIONS

Do cough medicines work for pertussis?

No, over-the-counter cough medicines are generally not effective for whooping cough and are discouraged, especially for young children. Antibiotics and time are the main treatments.

Babies are hospitalized not just for the cough, but also to monitor for apnea (breathing pauses), ensure they get enough oxygen, and help with feeding if they are vomiting frequently.

A person is typically no longer contagious after completing five full days of antibiotic treatment. Without antibiotics, they can be infectious for 3 weeks or more.

This is called prophylaxis. It helps kill any bacteria they might have picked up before symptoms start, preventing them from getting sick or spreading it to others.

Yes, a cool-mist humidifier can help keep the air moist, which may soothe the irritated airways and loosen thick mucus, making it easier to breathe.

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