{short description of image} Linn County Public Health

501 13th Street NW
Cedar Rapids, IA 52405-3700

February 6, 2002

 

Dear Health Care Provider:

Your patient has had significant contact with a case of pertussis and is being referred to you for Erythromycin prophylaxis. The recommendations for treatment and prophylaxis are the same. If treatment is begun early, symptoms of pertussis may be modified. If treatment begins later in the course of illness, it may not decrease symptoms. However, it will decrease the period of infectiousness. The following recommendations are from the Centers from Disease Control (CDC):

Drug

Child

Adult

Erythromycin

(drug of choice)

40-50 mg/kg/day orally in four divided doses for 14 daysk (maximum 2 grams/day)

1-2 grams/day orally in four divided doses for 14 daysk

(maximum 2 grams/day)

Trimethoprim-sulfamethoxazole (alternative, but efficacy is unknown)

Trimethoprim 8 mg/kg/day, sulfamethoxazole 40 mg/kg/day orally in two divided doses for 14 days

Trimethoprim 320 mg/day, suflamethoxazole 1,600 mg/day orally in two divided doses for 14 days

Clarithromycin (alternative, but efficacy is unknown)

15 mg/kg/day orally in two divided doses for 10-14 days (maximum 1 gram/day)

500 mg orally 2 times per day for 10-14 days

k Because relapses have been observed after completion of 7-10 days of treatment with Erythromycin, 14 days of treatment has been recommended.

Asymptomatic close contacts may return to school/work immediately after initiation of antibiotic prophylaxis.

The history obtained in the exposure setting suggests that your patient is asymptomatic. However, we advise you to re-evaluate your patient for symptoms of pertussis. Significant symptoms compatible with pertussis are a prolonged cough, paroxysmal cough or a cough with post-tussive vomiting. However, even milder symptoms should be regarded as suspicious.

  1. Unless a specific medical contraindication exists, place symptomatic close contacts on erythromycin. If the patient’s symptoms are highly suggestive of pertussis, consider treating all household contacts with erythromycin. (See table.)

    Trimethoprim/ sulfamethoxazole or Clarithromycin are acceptable alternatives for those unable to tolerate erythromycin. (See table.)

  2. If your patient is symptomatic, obtain appropriate laboratory confirmation as indicated by duration of symptoms.

    Isolation of the organism using culture is most successful the first 1-2 weeks of cough. Obtain a nasopharyngeal culture and polymerase chain reaction (PCR) test for Bordetella pertussis. Specimen kits are available from the University Hygienic Laboratory at 319/335-4500.

  3. Advise symptomatic students to refrain from public activities until 5 days of antibiotic therapy have been completed. If student or household contacts are not symptomatic and are on antibiotics, they do not need to restrict their public activities.
     
  4. Due to the great potential for silent transmission in families, we recommend all household contacts of diagnosed cases receive prophylaxis as indicated above.
     
  5. In addition to antibiotic prophylaxis, please assure contacts less than 7 years old are age appropriately immunized against pertussis.

If you have any questions, please do not hesitate to contact the Linn County Public Health Department at 892-6000.

Sincerely,

Linn County Public Health