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Whooping cough

May 6, 2020

Whooping cough (Pertussis) is a highly contagious infection caused by bacteria Bordetella Pertussis. It is an airborne disease and transmitted through cough droplets. It most commonly affects children and presents with symptoms of prolonged cough; classic inspiratory ‘whooping’ sound; fainting and vomiting. In severe cases it may lead to syncope or aspiration. Patient will need isolating during the acute phase.

Medications:

Primary treatments:

  • Children – Syrup Azee (Azithromycin 200 mg/5ml) – 10 mg/kg orally once a day on first day followed by 5 mg/kg once daily for another 5 days.
  • Adult: Tab. Azee 250 (Azithromycin 250 mg) 500 mg (2 tablets) once a day on first day followed by 250 mg once a day for another 5 days.

If patient fails to respond or presents with severe symptoms add:

  • Children – Dry syrup Moxikind-CV (Amoxicillin 200 mg; Clavulanic acid 28.5 mg) – 12.5 mg/kg orally twice a day for 10 days.
  • Children – Syrup Flora BC (Lactic acid bacillus; Pyridoxine, Niacinamide, Folic acid) – 5 mls twice a day for 10 days.
  • Adults – Tab. Moxikind CV 625 (Amoxicillin 500 mg, Clavulanate 125 mg) – 1 tablet twice a day for 7 days.
  • Adult – Cap. Flora BC (Lactic acid bacillus; Pyridoxine, Niacinamide, Folic acid) – 1 capsule twice a day for 10 days.

 Supportive treatments:

Montelukast –

  • Age 1 – 5 years – Syrup Montair LC Kid (Montelukast 4 mg/5ml, Levocetrizine 2.5 mg/5ml) – 5 mls  once a day.
  • Age 6 – 14 years – Tab. Montair 5mg Chewable (Montelukast 5 mg) 1 tablet once a day.
  • Age 15 years or older – Tab. Telekast 10 (Montelukast 10 mg) 1 tablet once a day.

Nebulized Asthalin Respirator Solution (Salbutamol 5mg/ml) –

  • If weight < 10 kg – 25 mg (0.25 ml) in 2 ml normal saline every six hours, delivered over 10 minutes. Do not exceed 4 doses/day.
  • 10 kg to 35 kg – 2.5 mg (0.5 ml) in 2 ml normal saline every six hours, delivered over 10 minutes. Do not exceed 4 doses/day.
  • Weight > 35 kg – 5 mg (1 ml) in 2 ml normal saline every six hours, delivered over 10 minutes. Do not exceed 4 doses/day.

General advice:

  • Maintain nutrition during periods of prolonged cough with liquid diet
  • Ensure patient has plenty of fluids.

Investigations:

  • Throat swab for B. Pertussis bacteria
  • Pertussis PCR
  • CBC – to identify raised white cell count

Referral:

Consider referring patient to chest physician if patient fails to improve or presents with additional complications.