Patient handout

Pertussis (whooping cough) — Bordetella pertussis — catarrhal + paroxysmal + convalescent phases + infant pertussis (apnea, pneumonia, pulmonary hypertension) + adult atypical + post-exposure prophylaxis + maternal Tdap at 27-36 wk every pregnancy + DTaP/Tdap vaccination schedule + cocooning

PRODUCTION

1. Your condition

This handout is for pertussis (whooping cough) — bordetella pertussis — catarrhal + paroxysmal + convalescent phases + infant pertussis (apnea, pneumonia, pulmonary hypertension) + adult atypical + post-exposure prophylaxis + maternal tdap at 27-36 wk every pregnancy + dtap/tdap vaccination schedule + cocooning. Your care team identified this based on: paroxysmal cough lasting > 2 wk + inspiratory whoop or post-tussive emesis + inter-paroxysm well-appearance — pathognomonic pertussis paroxysmal phase (cherry pediatrics 2005 pmid 15876920; aap red book 2024).

Other reasons your team may use this plan: catarrhal phase (1-2 wk) uri-like (coryza, mild cough, low-grade fever) + outbreak / exposure context — most contagious phase; treatment within this window dramatically reduces transmission (cherry pediatrics 2005; cdc pertussis); apnea / cyanosis in infant < 6 mo (paroxysmal cough may be absent or minimal) — high mortality infant phenotype; cardiopulmonary monitoring + azithromycin + icu consideration (aap red book 2024; cdc pertussis); respiratory distress / new bilateral infiltrates / spo2 < 94% in pertussis context — primary b. pertussis pneumonia or bacterial superinfection; empiric ceftriaxone ± vancomycin (aap red book 2024; idsa/ats cap 2019).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
azithromycin	Infant < 6 mo: 10 mg/kg PO daily × 5 d; Infant 6 mo+ / child / adolescent: 10 mg/kg day 1 (max 500 mg) then 5 mg/kg × 4 d (max 250 mg); Adult: 500 mg day 1 then 250 mg PO daily × 4 d	PO	daily × 5 d	First-line per CDC pertussis + AAP Red Book 2024 + Tiwari MMWR 2005 PMID 16340941; short 5-d course; better tolerated than 14-d erythromycin per Altunaiji Cochrane 2007 PMID 17636756; preferred in < 1 mo per AAP — hypertrophic pyloric stenosis ~ 2-3× background risk (lower than erythromycin ~ 7×); monitor for vomiting in neonates post-azithromycin

Plan: Pertussis azithromycin treatment (first-line all ages incl. < 1 mo) + erythromycin alternative > 1 mo + TMP/SMX alternative > 2 mo + PEP azithromycin for close contacts within 21 d + empiric bacterial co-empirics for superinfection + supportive care + maternal Tdap at 27-36 wk every pregnancy + DTaP routine pediatric series + Tdap adolescent + adult every 10 yr + cocooning

3. When to call your provider

Contact your care team if any of the following happen:

New respiratory distress / oxygen level (SpO₂) < 94% / apnea / cyanosis → urgent ED + CXR + IV antibiotics if bacterial superinfection features
New neuro signs / seizures → urgent ED + MRI + LP
Dehydration with inability to maintain oral intake → urgent ED + IV fluids
Persistent fever > 48-72 h or new fever spike post-rash → suspect bacterial superinfection → re-evaluate
WBC > 100,000 with lymphocyte predominance → urgent ED + ICU + exchange transfusion / leukapheresis consideration
Infant sibling with apnea / cyanosis in household with index pertussis → urgent ED + cardiopulmonary monitoring

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Infant < 6 mo with confirmed/suspected pertussis (any phase: catarrhal, paroxysmal, convalescent) — life-threatening; admit (cardiopulmonary monitoring for apnea — apnea may be the only feature; whoop and post-tussive emesis often absent in infants); supportive (O2, NIV, ICU as needed); azithromycin first-line (10 mg/kg/d PO × 5 d; NEVER erythromycin < 1 mo per AAP — hypertrophic pyloric stenosis ~ 7× background risk per Honein Lancet 1999 PMID 10609814 + Eberly Pediatrics 2015 PMID 25687145); ID consult; STAT public health notification (CDC pertussis; AAP Red Book 2024)(life-threatening)
Apnea episodes in infant pertussis (may precede or replace classic paroxysms; whoop and post-tussive emesis often absent) — life-threatening; ICU + continuous cardiopulmonary monitoring + apnea alarms; supplemental O2 + NIV / mechanical ventilation if severe; mortality 1-2% in infants < 6 mo developed-world (up to 5-10% developing world); cross-route to peds.brue.v1 for BRUE / ALTE differential framework — pertussis must be ruled out before BRUE diagnosis (AAP Red Book 2024; CDC pertussis)(life-threatening)
Pertussis pneumonia (primary B. pertussis pneumonia OR bacterial superinfection — MRSA, S. pneumoniae, S. aureus, H influenzae) — severe; admit (ICU if respiratory failure); supportive O2 ± ventilation; **continue azithromycin** for pertussis + **add empiric ceftriaxone ± vancomycin** per IDSA HAP/CAP if bacterial superinfection features (focal consolidation, procalcitonin > 0.25, leukocytosis with neutrophil predominance, clinical deterioration); cross-route to pulm.cap.core.v1 (AAP Red Book 2024; IDSA/ATS CAP 2019; IDSA HAP/VAP 2016)
Pertussis encephalopathy (~ 0.3-1%) or seizures (~ 2%) — life-threatening; admit ICU + supportive + neurology + EEG + MRI + LP + CSF studies (rule out bacterial meningitis + viral encephalitis); anoxic + hypoxic + direct-toxin etiologies; substantial mortality + permanent neurologic sequelae; continue azithromycin for pertussis; cross-route to id.bacterial-meningitis.core.v1 / .peds.v1 via workup.first_seizure for differential framework (AAP Red Book 2024; CDC pertussis)(life-threatening)
ANY suspected/confirmed pertussis case → IMMEDIATE notification of state/local public health (do NOT wait for laboratory confirmation) + droplet isolation + outbreak investigation + contact tracing (close contacts within 21 d of cough onset of index case); every pertussis case is a notifiable disease per CDC + state law; cohort isolation if institutional outbreak (school, childcare, healthcare) (CDC pertussis; state notifiable-disease law)
Unvaccinated or partially vaccinated child (< 5 DTaP doses) in pertussis outbreak context (community, school, childcare, healthcare) → severe; **catch-up DTaP per ACIP catch-up schedule** + cocooning strategy for household contacts + close-contact monitoring + cohort isolation if school / childcare outbreak; STAT public health notification (CDC pertussis; AAP Red Book 2024; ACIP)
Infant < 1 mo with pertussis → AVOID ERYTHROMYCIN per AAP — hypertrophic pyloric stenosis ~ 7× background risk per Honein Lancet 1999 PMID 10609814 + Eberly Pediatrics 2015 PMID 25687145 + subsequent cohorts; **USE AZITHROMYCIN** (10 mg/kg/d × 5 d) — lower but still elevated pyloric stenosis risk than erythromycin (~ 2-3× background); monitor for vomiting post-azithromycin in neonates (CDC pertussis; AAP Red Book 2024; Tiwari MMWR 2005 PMID 16340941)

5. Follow-up

Post-pertussis: paroxysm-free convalescence; counsel on "100-day cough" persistence; return precautions for new respiratory features; vaccination reconciliation (DTaP routine pediatric audit; Tdap adolescent at 11-12 yr; adult every 10 yr; maternal at 27-36 wk every pregnancy; cocooning for close contacts of newborns). Post-pertussis pneumonia: respiratory recovery + lung function; ID follow-up if immunocompromised. Post-encephalopathy: neurology + neuropsychology + rehabilitation; serial imaging + functional assessment. Family education + contact tracing if institutional outbreak; public health reporting through resolution; close-contact PEP audit (azithromycin within 21 d of cough onset of index case).

6. Sources

Guideline: CDC Pertussis Treatment + Prevention Guidance (current 2024-2025) + AAP Red Book current edition (2024 + 2026 floor) Pertussis chapter + ACIP Pertussis / Tdap recommendations (maternal Tdap at 27-36 wk every pregnancy regardless of prior status) + Liang MMWR 2018 ACIP Tdap/DTaP comprehensive recommendation + Tiwari MMWR 2005 CDC pertussis treatment + PEP + Cherry Pediatrics 2005 adult / adolescent atypical pertussis review + Honein Lancet 1999 erythromycin neonatal pyloric stenosis + Eberly Pediatrics 2015 azithromycin neonatal pyloric stenosis + Skoff CID 2017 maternal Tdap timing 27-36 wk antibody transfer + Skoff CID 2017 maternal Tdap effectiveness 78-91% infant hospitalization reduction + Klein NEJM 2012 post-DTaP-era resurgence epidemiology + Klein NEJM 2012 DTaP waning immunity 5-10 yr + Altunaiji Cochrane 2007 antibiotics for pertussis meta-analysis + WHO Pertussis Guidelines 2024 + IDSA/ATS CAP 2019 bacterial superinfection + ACOG Practice Advisory Tdap in Pregnancy