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Meta-Analysis
. 2007 Jul 18;2007(3):CD004404.
doi: 10.1002/14651858.CD004404.pub3.

Antibiotics for whooping cough (pertussis)

S Altunaiji  1 , R Kukuruzovic, N Curtis, J Massie
Affiliations
Meta-Analysis

Antibiotics for whooping cough (pertussis)

S Altunaiji et al. Cochrane Database Syst Rev. .

Abstract

Background: Whooping cough is a highly contagious disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis, but is of uncertain benefit.

Objectives: To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 1, 2007); MEDLINE (January 1966 to March 2007); EMBASE (January 1974 to March 2007).

Selection criteria: All randomised and quasi-randomised controlled trials of antibiotics for treatment of, and contact prophylaxis against, whooping cough.

Data collection and analysis: Three to four review authors independently extracted data and assessed the quality of each trial.

Main results: Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis.

Authors' conclusions: Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 2 Complete remission (clinical cure).
1.3
1.3. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 3 Clinical improvement (better condition) after one week.
1.4
1.4. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 4 Decreased frequency of cough.
1.5
1.5. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 5 Presence of any sign or symptoms of whooping cough.
1.6
1.6. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 6 Microbiological eradication.
1.7
1.7. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 7 Bacteriological relapse.
1.8
1.8. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 8 Respiratory complications.
1.9
1.9. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 9 Complications (otitis media).
1.10
1.10. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 10 All side effects.
1.11
1.11. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 11 Gastro‐intestinal system side effects.
1.12
1.12. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 12 Side effects (diarrhoea).
1.13
1.13. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 13 Compliance (detected by antimicrobial activity in urine).
1.14
1.14. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 14 Compliance (presented as number of children who took 100% of prescribed doses).
1.15
1.15. Analysis
Comparison 1 Antibiotics for treatment of whooping cough, Outcome 15 Compliance (presented as percentage of drugs taken).
2.1
2.1. Analysis
Comparison 2 Antibiotics 3 to 7 days versus antibiotics for 10 to 14 days in treatment of whooping cough (subgroup analysis, Outcome 1 Presence of any sign or symptoms of whooping cough.
2.2
2.2. Analysis
Comparison 2 Antibiotics 3 to 7 days versus antibiotics for 10 to 14 days in treatment of whooping cough (subgroup analysis, Outcome 2 Microbiological eradication.
2.3
2.3. Analysis
Comparison 2 Antibiotics 3 to 7 days versus antibiotics for 10 to 14 days in treatment of whooping cough (subgroup analysis, Outcome 3 Microbiological eradication.
2.4
2.4. Analysis
Comparison 2 Antibiotics 3 to 7 days versus antibiotics for 10 to 14 days in treatment of whooping cough (subgroup analysis, Outcome 4 Bacteriological relapse.
2.5
2.5. Analysis
Comparison 2 Antibiotics 3 to 7 days versus antibiotics for 10 to 14 days in treatment of whooping cough (subgroup analysis, Outcome 5 All side effects.
2.6
2.6. Analysis
Comparison 2 Antibiotics 3 to 7 days versus antibiotics for 10 to 14 days in treatment of whooping cough (subgroup analysis, Outcome 6 All side effects.
3.1
3.1. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 1 All (any) clinical symptoms.
3.2
3.2. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 2 Presence of all (any) cough.
3.3
3.3. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 3 Paroxysmal cough.
3.4
3.4. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 4 Frequency of whoop in contacts.
3.5
3.5. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 5 Frequency of whooping cough in contacts.
3.6
3.6. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 6 Frequency of whooping cough in vaccinated contacts.
3.7
3.7. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 7 Frequency of whooping cough in unvaccinated contacts.
3.8
3.8. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 8 Culture‐positive after prophylaxis in contacts (attack rate post‐prophylaxis).
3.9
3.9. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 9 Culture‐positive or paroxysmal cough > 2 weeks after prophylaxis in contacts (attack rate post‐prophylaxis).
3.10
3.10. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 10 All (any) side effects.
3.11
3.11. Analysis
Comparison 3 Antibiotic for prophylaxis of whooping cough, Outcome 11 Compliance (> 90% of doses).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Aoyama 1996 {published data only}
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References to other published versions of this review

Altunaiji 2005
    1. Altunaiji S, Kukuruzovic R, Curtis N, Massie J. Antibiotics for whooping cough (pertussis). Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD004404.pub3] - DOI - PubMed
Altunaiji 2007
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