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 NICE CKS.
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 NICE CKS. If macrolides are contraindicated or not tolerated, co-trimoxazole is an alternative but should not be used in infants younger than six weeks NICE CKS.
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 NICE CKS 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 NICE CKS. 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 NICE CKS.
Vaccination should be arranged after recovery to complete the childhood immunization schedule, as unvaccinated children are at higher risk of severe disease and complications NICE CKS. Post-exposure vaccination in pregnant contacts is also vital to protect young infants NICE CKS.
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.