Pertussis (Whooping cough)

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- Notify Public Health.

- For contact prophylaxis recommendations, see Prophylaxis for Contacts of Communicable Diseases.

- Persistent cough (≥ 6 days) in adults and adolescents may indicate whooping cough in up to 32%.

- Cough with vomiting in adults represents high likelihood for whooping cough.

- Typical course of pertussis:

1) catarrhal phase - lasts 1-2 weeks; most contagious

2) paroxysmal phase - 3-6 weeks.

3) convalescent phase - > 6 weeks (mean duration of cough is 6 weeks).


- cough present for up to 3 weeks - order culture and PCR of posterior nasopharynx (aspirate/swab)

- cough present > 3 weeks - order PCR (beyond 4 weeks, PCR likely to be negative)

Antibiotic therapy

- Antibiotic therapy may reduce the duration or severity of symptoms (only if started in catarrhal phase) and limits transmission to susceptible contacts. Because viable organisms can be recovered from untreated patients for 3 weeks after onset of cough, a 5-7 day course of antibiotics is recommended during the first 4 weeks of illness. For individuals likely to be in contact with high risk contacts (infants, pregnant women in 3rd trimester, health care workers, child care workers who care for infants), a 5-7 day course of antibiotics is recommended during the 6-8 weeks after onset of illness.



- Adults are an important reservoir for pertussis and transmission to children, and pertussis in adults is associated with considerable morbidity (otitis, sinusitis, pneumonia, urinary incontinence).

- All adults who have not previously had a dose of acellular pertussis vaccine should receive a single dose.

Usual Pathogens

Bordetella pertussis


Empiric Therapy Dose Duration
Azithromycin 500mg PO first day then 5 days
  250mg PO daily x 4 days  
Clarithromycin 500mg PO bid or 7 days
  XL 1g PO daily  
Erythromycin base 500mg PO qid 7 days


Empiric Therapy Dose Duration
TMP/SMX 1 DS tab PO bid 10 days