How should I manage a child with suspected pertussis who has not been vaccinated?

In managing a child with suspected pertussis who has not been vaccinated, immediate clinical assessment is essential, with a low threshold for hospital admission if the child is aged 6 months or younger or shows significant breathing difficulties such as apnoea, severe paroxysms, or cyanosis, or complications like seizures or pneumonia ¹.

Antibiotic treatment should be initiated promptly if the cough onset is within the previous 14 days. The first-line treatment is a macrolide antibiotic: for infants under 1 month, clarithromycin is preferred, while azithromycin or clarithromycin can be used for children aged 1 month or older ¹. If macrolides are contraindicated or not tolerated, co-trimoxazole is an alternative but should not be used in infants younger than six weeks ¹.

Supportive care includes advising rest, adequate fluid intake, and symptomatic relief with paracetamol or ibuprofen. Families should be informed that the cough may persist for several weeks despite antibiotic treatment, but symptoms tend to be less severe and resolve faster if the child has been immunized or previously infected ¹ (Munoz, 2006).

Exclusion from nursery or school is required until the child has completed 48 hours of appropriate antibiotic treatment or for 14 days from the onset of coughing if untreated ¹. Close contacts, especially those in priority groups such as infants under 1 year or pregnant women, should be managed with consideration of antibiotic prophylaxis and vaccination catch-up ¹.

Vaccination should be arranged after recovery to complete the childhood immunization schedule, as unvaccinated children are at higher risk of severe disease and complications ¹. Post-exposure vaccination in pregnant contacts is also vital to protect young infants ¹.

Overall, this approach aligns with expert opinion and literature emphasizing early antibiotic therapy to reduce transmission and severity, supportive care, and vaccination to prevent future infection (Munoz, 2006).