|Clinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)|
|Chapter 7 - Bacterial infections|
Whooping cough is a childhood disease characterized by paroxysmal
cough and tenacious sputum and caused by Bordetella pertussis. In developing
countries it contributes to malnutrition.
- The cough can recur up to one year after the initial infection.
- Infants less than 3 months may develop apneic episodes or periods of hypoxia (cyanosis) without cough which may be fatal.
- Anorexia may precipitate protein-calorie malnutrition.
- Sub conjunctival hemorrhages, epistaxis, hemoptysis .
- Secondary infections of the upper and lower respiratory system.
- Some authorities recommend antibiotic treatment during the prodromal (catarrhal) stage. This will not alter the course of the disease, but may reduce the period of infectivity and thus reduce transmission.
This is not practical except during epidemics, when all "colds"
can be assumed to be prodromal pertussis.
erythromycin(PO): 50 mg/kg/d divided in 3 doses x 7 days
chloramphenicol(PO): 50 mg/kg/d divided in 3 doses x 7 days
- During the paroxysmal stage, antibiotics are of no use. Advise the mother to ensure adequate hydration, to humidify the air if possible, to remove the tenacious strands of sputum from the oropharynx, and, most important, to continue good nutrition, in spite of the child's anorexia and even if there is vomiting with each coughing spasm (feed the child again after the episode of vomiting).
- Secondary infections: antibiotics PO, IM or IV depending on
ampicillin (PO): 100 mg/ kg/ d divided in 3 doses x 5-10 days
chloramphenicol(PO): 50 to 75 mg/kg/d divided in 3 doses x 5-10 days
cotrimoxazole (PO): 40 mg of SMX/kg/d divided in 2 doses x 5-10 days
- Infants less than 3 months of age should be admitted to hospital, if possible, and observed 24 hours a day.
- Immunization (part of the routine program).
- During epidemics selective immunization of non-immune infants not manifesting clinical illness who have been in contact with pertussis cases.