RISK FACTORS: Unimmunized children, Contact with an infected person, Epidemic exposure, Pregnancy
GENERAL MEASURES
β’ General supportive, skilled nursing care
β’ Isolation and quarantine for 4 weeks; 5 days after erythromycin started
β’ Parenteral fl uid therapy if needed
β’ Oxygen
β’ Careful observation for apnea in young infants, and, to avoid stimuli that trigger paroxysms
β’ Mechanical ventilation
β’ Nutritional support - may require tube feedings in infants
ACTIVITY Rest during active phase in quiet environment
DIET Encourage extra fl uids. May need to provide small frequent meals to assure adequate nutrition.
DRUG(S) OF CHOICE
β’ Erythromycin, 40-50 mg/kg/day divided doses q 6 h for 14 days; drug of choice, maximum 2 g/day
β’ Azithromycin, 10 mg/kg/day in 1 dose for fi ve days, maximum 500 mg/day, for 5 days
β’ Clarithromycin, 15-20 mg/kg/day in 2 divided doses, maximum 1 g/day, for 7 days
β’ Penicillins and cephalosporins not effective
β’ Other antibiotics for bacterial complications such as bronchopneumonia or otitis media
β’ Antibiotics do not alter course of illness unless given very early, however they prevent transmission.
ALTERNATIVE DRUGS
β’ Steroids and/or theophylline have been suggested for treatment of severely ill patients (their effectiveness and potential hazards require further controlled studies)
β’ Beta-2 agonists (e.g., albuterol) may help with cough paroxysms
β’ Trimethoprim-sulfamethoxazole
PATIENT MONITORING
β’ Intensive care unit may be necessary for severely ill infants
β’ Older children and adults with mild cases do not need to be confined to bed or admitted to hospital
PREVENTION/AVOIDANCE
β’ Respiration isolation of infected persons until treated with erythromycin 5 days
β’ Immunization for all infants, usually combined with diphtheria and tetanus toxoids (DTaP). Immunization or
booster not recommended after age 7 years.
β’ Erythromycin - (40 mg/kg/day in 4 divided doses, maximum 2 g/day for 14 days, for all household and close contacts (e.g., day-care) )
β’ Immediately immunize all unimmunized contacts under age 7
β’ Observe contacts for symptoms for 21 days after exposure
β’ Classroom prophylaxis not recommended
POSSIBLE COMPLICATIONS
β’ Can infect up to 80% of household members who are not immune
β’ Death, especially in infants
β’ Pneumonia
β’ Encephalopathy
β’ Coma
β’ Otitis media
β’ Tuberculosis activation
β’ Epistaxis
β’ Hernia
β’ Re-induction of paroxysmal coughing (for several months) especially with upper respiratory infections
β’ Seizures
β’ Cerebral hemorrhage
β’ Weight loss
β’ Hemoptysis
β’ Atelectasis