Information for GPs – please distribute to all medical and nursing staff
Background
• Whooping cough (pertussis) is a bacterial respiratory infection that can cause severe disease or
rarely death in infants.
• It typically presents as a persistent cough, often worse at night.
• Early treatment with antibiotics stops transmission and may reduce the duration of symptoms.
Recommendations – Antibiotic Treatment as per Therapeutic Guidelines
Antibiotic <1 mth 1 – <6 mths Children ≥6
mths Adults Pregnancy Frequency Duration
Azithromycin 10mg/kg 10mg/kg Day 1: 10mg/kg
(max 500mg)
Day 1:
500mg
Day 1:
500mg
Daily 5 days
Days 2-5:
5mg/kg (max
250mg)
Days 2-5:
250mg
Days 2-5:
250mg
Clarithromycin 7.5mg/kg
(max
500mg)
7.5mg/kg (max
500mg)
7.5mg/kg (max
500mg)
500mg 500mg Twice a day 7 days
Trimethoprim +
Sulfamethoxazole
N/A 4+20mg/kg (max
160+800mg)
4+20mg/kg
(max
160+800mg)
160+800mg NOT to be
used in 1st or
3
rd trimester
Twice a day 7 days
Note: Antibiotic therapy is not indicated 21 days or more after cough onset, as after this time patients are no
longer infectious and antibiotics don’t change the clinical course of the disease.
Macrolides are compatible with breastfeeding (infant may have loose bowel motions). Trimethoprim +
sulfamethoxazole should be avoided in breastfeeding if neonate is preterm, unwell or has hyperbilirubinaemia.
Recommendations – Vaccination – National Immunisation Program funded
• Offer all pregnant women diphtheria-tetanus-pertussis (dTp adult formulation) vaccine between
20-32 weeks gestation in each pregnancy to provide passive immunity at birth to their infant.
Administer vaccine as early as possible (from 20 weeks) to women at high risk of early delivery.
• Health care workers recommending the pertussis vaccine during pregnancy is the main reason why
women choose to have this safe and effective vaccine to protect their infant.
• Vaccinate infants on time at 6 weeks, 4 months & 6 months with Infanrix hexa or Vaxelis.
Diagnosis
• Bordetella pertussis PCR on a nasopharyngeal (preferred) or throat swab. Pertussis PCR may be
included in respiratory multiplex PCR panels – check with your pathology provider.
• Serology is not recommended for detecting infection.
Response to cases
• If the household contains women in the last month of pregnancy, or infants who haven’t received
their 6-month vaccines, prescribe antibiotic treatment (per table above) for all household members,
provided it is within 14 days of first contact with your patient when they were infectious. Your
patient was infectious from when they first had any symptoms until 21 days after cough onset.
• Check if your patient has had any contact with women in the last month of pregnancy, infants, or
attended childcare while infectious – if so notify your local public health unit on 1300 066 055.
• Ask your patient to not attend school, childcare or any place with infants or pregnant women until
they have completed at least 5 days of antibiotics or it is 21 days after the onset of their cough.
For further information
• See your HealthPathways or NSW Health
https://www.health.nsw.gov.au/Infectious/whoopingcough/Pages/workers.aspx