Antibiotics for whooping cough (pertussis).
BACKGROUND
Whooping cough is a highly contagious disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis, but is of uncertain benefit.


OBJECTIVE
To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 1, 2007); MEDLINE (January 1966 to March 2007); EMBASE (January 1974 to March 2007).


METHODS
All randomised and quasi-randomised controlled trials of antibiotics for treatment of, and contact prophylaxis against, whooping cough.


METHODS
Three to four review authors independently extracted data and assessed the quality of each trial.


RESULTS
Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis.


CONCLUSIONS
Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.
Altunaiji
S
S
Zayed Military Hospital, Paedatrics Department, PO Box 12898, Aldhaid, Sharjah, United Arab Emirates. altunaiji1@gmail.com
Kukuruzovic
R
R
Curtis
N
N
Massie
J
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D001886:Bordetella pertussis; D017291:Clarithromycin / Q000627:therapeutic use; D016358:Contact Tracing; D004917:Erythromycin / Q000627:therapeutic use; D004918:Erythromycin Estolate / Q000627:therapeutic use; D015643:Erythromycin Ethylsuccinate / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016032:Randomized Controlled Trials as Topic; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014917:Whooping Cough / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission
D000900:Anti-Bacterial Agents; D015643:Erythromycin Ethylsuccinate; D004917:Erythromycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017963:Azithromycin; D017291:Clarithromycin; D004918:Erythromycin Estolate