# Pertussis (Whooping Cough) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC Pertussis Postexposure Prophylaxis and Treatment 2019 · CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html) · Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph) - Verified date: 2026-08 ## Verified against - CDC Pertussis Postexposure Prophylaxis and Treatment 2019 - CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html) - Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph) - Pertussis - disease-level clinical article (pertussis-clinical.txt) - MSF Essential Drugs 2024 ## Treatment metadata - Azithromycin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Clarithromycin — 500 mg — oral.solid - Co-trimoxazole — oral.solid ## Complete treatment card ```text PERTUSSIS (WHOOPING COUGH) Sources: CDC Pertussis Postexposure Prophylaxis and Treatment 2019 · CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html) · Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph) Review status: REVIEWED against CDC Pertussis Postexposure Prophylaxis and Treatment 2019, CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html), Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph), Pertussis - disease-level clinical article (pertussis-clinical.txt), MSF Essential Drugs 2024 (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Paroxysmal coughing fits, an inspiratory whoop, and vomiting after coughing are classic but not individually reliable [cough · vomiting] - A cough of any length with a known case contact, or a cough lasting at least 2 weeks with paroxysms, whoop, vomiting, or apnea, meets the case definition [apnoea · cough · vomiting] - Adults and teens often have just a prolonged cough over 2 weeks with no whoop or vomiting, which can delay diagnosis [cough] - Fever present, or no paroxysmal coughing at all, makes pertussis unlikely in an adult [fever] SIGNS - what you find (1) - In infants under 1 year old, apnea itself can be the presenting sign rather than a typical cough [apnoea] TESTS (5) - PCR testing is 77% to 97% sensitive and 88% to 97% specific when done within 1 to 4 weeks of symptom onset - Culture is 100% specific and remains the gold standard, but takes 7 to 10 days to grow - Serology is most useful 3 to 12 weeks after symptom onset but is unreliable in infants under 6 months or the recently vaccinated - A white count over 20,000 per microliter with more than half lymphocytes in an infant under 3 months strongly suggests pertussis - Fluorescent-antibody staining of secretions is now considered outdated and unreliable for diagnosis IF NOT THIS - what else fits (5) - A milder illness that needs PCR or culture to tell apart from true pertussis points to B. parapertussis - Fever, lung crackles, and higher CRP with a shorter cough course in a school-age child favor Mycoplasma over pertussis - A short 1 to 3 day incubation with fever and a non-paroxysmal cough points to a viral cause instead - Wheeze that responds to a bronchodilator, without whooping paroxysms, favors asthma over pertussis - A sudden-onset cough with a choking history and one-sided wheeze suggests foreign body aspiration rather than pertussis Source StatPearls "Pertussis" - disease-level clinical article Status traced to the source above 1. AZITHROMYCIN [1st line] Adult 500 mg single dose on Day 1, then 250 mg once daily on Days 2-5 x 5 days Peds Under 6 months: 10 mg/kg once daily for 5 days - the same dose every day, not a step- down 6 months and over: 10 mg/kg (maximum 500 mg) on day 1, then 5 mg/kg (maximum 250 mg) once daily on days 2 to 5 (Two different regimens - check the age first. Under 6 months: 10 mg/kg once daily for 5 days, the same dose every day. 6 months and over: 10 mg/kg (max 500 mg) on day 1, then 5 mg/kg (max 250 mg) once daily on days 2-5. It is not a step-down under 6 months, and halving day 2 in a young infant under-treats the group most likely to die of this.) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html) Why First-line macrolide therapy; preferred over erythromycin due to shorter duration and better compliance Caution Azithromycin is the macrolide of choice under 1 month. Erythromycin is associated with infantile hypertrophic pyloric stenosis and clarithromycin is not recommended in this age group - but the risk of untreated pertussis in a neonate outweighs the risk of IHPS. Early treatment (catarrhal phase) reduces disease severity; treatment in paroxysmal phase mainly prevents transmission. Monitor infants <6 weeks for infantile hypertrophic pyloric stenosis with macrolides. POST-EXPOSURE PROPHYLAXIS, article verbatim: "PEP is recommended for household and close contacts, particularly those at high risk (infants, pregnant women, and immunocompromised individuals) and for healthcare personnel exposed to high-risk patients." The prophylactic regimen is this same regimen, and there is a deadline: "PEP is most effective when initiated within 21 days of cough onset in the index case. The same macrolide regimens used for treatment (typically azithromycin) are recommended for prophylaxis." Being vaccinated does not exempt a contact: "Regimens mirror treatment antibiotics (commonly azithromycin), and prior vaccination does not obviate the need for PEP." Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 21.50 EGP (7.17/unit) AZITHROMASH 500 MG 3 F.C. TABS. MASH PREMIERE 48.00 EGP (16.00/unit) AZALIDE 500MG 3 CAPS. UP PHARMA 52.00 EGP (17.33/unit) AZROLID 500 MG 6 F.C.TABS. AMRIYA 126.00 EGP (21.00/unit) ZERAMERATE 500 MG EGPI > GAMMA ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Pertussis - disease-level clinical article (pertussis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Infants younger than 6 months may need hospitalization, given the risk of apnea, hypoxia, dehydration, and pneumonia. 3. CLARITHROMYCIN [2nd line] Adult 500 mg twice daily x 7 days Peds 7.5 mg/kg/dose [child max 500 mg] (7.5 mg/kg twice daily for 7 days) 3kg -> 22.5 mg/dose 4kg -> 30 mg/dose 5kg -> 37.5 mg/dose 6kg -> 45 mg/dose 7kg -> 52.5 mg/dose 8kg -> 60 mg/dose 9kg -> 67.5 mg/dose 10kg -> 75 mg/dose 11kg -> 82.5 mg/dose 12kg -> 90 mg/dose 13kg -> 97.5 mg/dose 14kg -> 105 mg/dose 15kg -> 112.5 mg/dose 16kg -> 120 mg/dose 17kg -> 127.5 mg/dose 18kg -> 135 mg/dose 19kg -> 142.5 mg/dose 20kg -> 150 mg/dose 21kg -> 157.5 mg/dose 22kg -> 165 mg/dose 23kg -> 172.5 mg/dose 24kg -> 180 mg/dose 25kg -> 187.5 mg/dose 26kg -> 195 mg/dose 27kg -> 202.5 mg/dose 28kg -> 210 mg/dose 29kg -> 217.5 mg/dose 30kg -> 225 mg/dose 31kg -> 232.5 mg/dose 32kg -> 240 mg/dose 33kg -> 247.5 mg/dose 34kg -> 255 mg/dose 35kg -> 262.5 mg/dose 36kg -> 270 mg/dose 37kg -> 277.5 mg/dose 38kg -> 285 mg/dose 39kg -> 292.5 mg/dose 40kg -> 300 mg/dose 41kg -> 307.5 mg/dose 42kg -> 315 mg/dose 43kg -> 322.5 mg/dose 44kg -> 330 mg/dose 45kg -> 337.5 mg/dose 46kg -> 345 mg/dose 47kg -> 352.5 mg/dose 48kg -> 360 mg/dose 49kg -> 367.5 mg/dose 50kg -> 375 mg/dose AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Choice Clarithromycin is the first choice here; co-trimoxazole is a further option. Source Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph) Why Clarithromycin is a macrolide antibiotic that reduces Bordetella pertussis carriage and transmission; it serves as an alternative macrolide to azithromycin, which remains preferred in very young infants. Caution Not recommended under 1 month - use azithromycin. Caution in renal impairment and QT prolongation risk. Clarithromycin is an alternative macrolide option. GI side effects (nausea, abdominal pain) are common. Egypt KAPIFECTIN 500 MG 14 F.C.TAB. EVA PHARMA 37.00 EGP (2.64/unit) LARITHROCIN 500MG 14 F.C. TABS. GLOBAL NAPI P... 40.00 EGP (2.86/unit) CAPRIVEXIN 500MG S.R. 14 F.C. TAB. HORUS FOR PHARMACEUTICAL... 58.00 EGP (4.14/unit) CLARINOTION XL 500 MG 14 F.C.TABS. RAMEDA > NOTION PHARMA 83.00 EGP (5.93/unit) KLARIMIX 500 MG 14 TAB. SIGMA > OCTOB... 144.00 EGP (10.29/unit) INFECTOCURE 500 MG 14 F.C.TABS. EGPI 156.00 EGP (11.14/unit) KLACID 500 MG 14 F.C.TABS. KAHIRA > ABBO... 257.00 EGP (18.36/unit) KLACID XL 500 MG 14 F.C.TABS. KAHIRA > ABBO... 299.00 EGP (21.36/unit) KLARIMIX 125MG/5ML SUSP. 60ML SIGMA 36.00 EGP -> ? strength differs, ? different route - not oral solid KLARIMIX 250MG/5ML SUSP. 60ML SIGMA 52.00 EGP -> ? strength differs, ? different route - not oral solid 4. CO-TRIMOXAZOLE [2nd line] Adult 800 mg SMX/160 mg TMP twice daily x 14 days Peds 4 mg/kg/dose [child max 160 mg] (Child 6 weeks and over: 20 mg SMX/4 mg TMP/kg (max 800 mg SMX/160 mg TMP) twice daily for 14 days) 3kg -> 12 mg/dose 4kg -> 16 mg/dose 5kg -> 20 mg/dose 6kg -> 24 mg/dose 7kg -> 28 mg/dose 8kg -> 32 mg/dose 9kg -> 36 mg/dose 10kg -> 40 mg/dose 11kg -> 44 mg/dose 12kg -> 48 mg/dose 13kg -> 52 mg/dose 14kg -> 56 mg/dose 15kg -> 60 mg/dose 16kg -> 64 mg/dose 17kg -> 68 mg/dose 18kg -> 72 mg/dose 19kg -> 76 mg/dose 20kg -> 80 mg/dose 21kg -> 84 mg/dose 22kg -> 88 mg/dose 23kg -> 92 mg/dose 24kg -> 96 mg/dose 25kg -> 100 mg/dose 26kg -> 104 mg/dose 27kg -> 108 mg/dose 28kg -> 112 mg/dose 29kg -> 116 mg/dose 30kg -> 120 mg/dose 31kg -> 124 mg/dose 32kg -> 128 mg/dose 33kg -> 132 mg/dose 34kg -> 136 mg/dose 35kg -> 140 mg/dose 36kg -> 144 mg/dose 37kg -> 148 mg/dose 38kg -> 152 mg/dose 39kg -> 156 mg/dose 40kg -> 160 mg/dose 41kg -> 160 mg/dose (capped) 42kg -> 160 mg/dose (capped) 43kg -> 160 mg/dose (capped) 44kg -> 160 mg/dose (capped) 45kg -> 160 mg/dose (capped) 46kg -> 160 mg/dose (capped) 47kg -> 160 mg/dose (capped) 48kg -> 160 mg/dose (capped) 49kg -> 160 mg/dose (capped) 50kg -> 160 mg/dose (capped) Source MSF Essential Drugs 2024 Why Second-line antibiotic alternative for pertussis in patients who cannot tolerate macrolides. Caution Contraindicated in infants under 6 weeks due to risk of hyperbilirubinemia. Contraindicated in severe renal or hepatic impairment or known hypersensitivity to sulfonamides. MSF Essential Drugs 2024, CO-TRIMOXAZOLE = SULFAMETHOXAZOLE (SMX)/TRIMETHOPRIM (TMP) oral monograph (pages 103-105), Contra-indications: do not give it where renal or hepatic impairment is severe, or where there is a history of hypersensitivity to a sulfonamide. Egypt CO-TRIMOXAZOLE 20 TABS. MUP 5.00 EGP (0.25/unit) COTRIL 400/80MG 20 TAB. EL NASR 38.00 EGP (1.90/unit) SEPTAZOLE FORTE 800/160MG 20 TABS. ALEXANDRIA 56.00 EGP (2.80/unit) SEPTRIN D.S 10 TABS. GLAXO SMITHKL... 28.00 EGP (2.80/unit) SEPTAZOLE 400/80MG 20*10 TABS. ALEXANDRIA 340.00 EGP (34.00/unit) SUTRIM 400/80MG 20*10 TAB. MEMPHIS 340.00 EGP (34.00/unit) CO-TRIMOXAZOLE 200/40MG SUSP. 120ML MUP 6.00 EGP -> ? strength differs, ? different route - not oral solid SUTRIM 200/40MG SUSP. 100ML MEMPHIS 18.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)