**5. Treatment**

Early antimicrobial treatment is recommended to reduce transmission and for disease control by protecting close contacts [55]. An antimicrobial can be administered as prophylaxis for close contacts of a person with pertussis if the person has no contraindication to its use.

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Individuals with pertussis are infectious from the beginning of the catarrhal period through the first week after the onset of paroxysms and until day 5 after the start of effective antimicrobial treatment.

The macrolide erythromycin has been the antimicrobial of choice for treatment or postexposure prophylaxis of pertussis [56]. It is usually administered in 4 divided daily doses for 14 days. Unfortunately, erythromycin is accompanied by uncomfortable to distressing side effects that result in poor adherence to the treatment regimen. Two other macrolide agents (azithromycin and clarithromycin) have been shown to be effective against *B. pertussis*. Azithromycin and clarithromycin are more resistant to gastric acid, achieve higher tissue concentrations, and have a longer half-life than erythromycin, allowing less frequent administration (1–2 doses per day) and shorter treatment regimens (5–7 days) [57]. Azithromycin is the preferred antimicrobial for use in infants younger than 1 month of age. The antibiotic doses recommended for infants aged <6 months comprise a regimen of 10 mg/kg per day for 5 days. For patients aged >6 months, 10 mg/kg on day 1, followed by 5 mg/kg per day during the next 4 days is recommended. For adults, 500 mg on day 1 is recommended, followed by 250 mg per day on the following 4 days. The regimen recommended for clarithromycin for infants and children aged >1 month is 15 mg/kg per day in two divided doses each day for 7 days. For adults, 1 g per day in two divided doses for 7 days is recommended. Clarithromycin is not prescribed in infants aged <1 month. Trimethoprim-sulfamethoxazole (TMP-SMZ) in a regimen of two doses a day for 14 days is used as an alternative to a macrolide antibiotic in patients aged >2 months who have contraindication to or cannot tolerate macrolide agents, or who are infected with a macrolide-resistant strain of *B. pertussis*. Resistance of *B. pertussis* to macrolides is rare, and antimicrobial susceptibility testing is not routinely recommended. Testing is appropriate in some circumstances and is recommended when treatment failure is suspected. TMP-SMZ should not be used to treat infants younger than 2 months of age [55].

Because data on the clinical effectiveness of antibiotic treatment against *B. parapertussis* are limited, treatment decisions should be based on clinical judgment [58].
