What is the appropriate antibiotic treatment for a confirmed case of pertussis in an adult patient?

Appropriate antibiotic treatment for a confirmed case of pertussis in an adult patient:

• Prescribe a macrolide antibiotic as first-line treatment.
• Preferred options are azithromycin or clarithromycin for non-pregnant adults.
• Azithromycin and clarithromycin are preferred over erythromycin due to better absorption, longer half-life, good activity against Bordetella pertussis, and a better adverse effect profile, which improves compliance.
• Antibiotics should ideally be given as soon as possible after onset of illness to eradicate the organism and limit transmission, although they do not significantly alter the clinical course if given late.
• If macrolides are contraindicated or not tolerated, co-trimoxazole may be used, but it is not recommended for pregnant women or infants under six weeks.

For pregnant women, erythromycin is recommended instead of azithromycin or clarithromycin.

Antibiotic treatment duration is typically short-term: azithromycin for 3–5 days, clarithromycin for 7 days, or erythromycin for 7 days, which are as effective as longer courses but with fewer adverse effects.

Advise patients that antibiotic treatment reduces transmission but may not shorten symptom duration, and symptoms can persist for several weeks.

Exclusion from work is recommended until 48 hours after starting appropriate antibiotic treatment.

These recommendations are based on Public Health England and UK Health Security Agency guidelines.

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