trimethoprim--sulfamethoxazole-drug-combination and Whooping-Cough

Whooping cough is a highly contagious disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis, but is of uncertain benefit.. To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 1, 2007); MEDLINE (January 1966 to March 2007); EMBASE (January 1974 to March 2007).. All randomised and quasi-randomised controlled trials of antibiotics for treatment of, and contact prophylaxis against, whooping cough.. Three to four review authors independently extracted data and assessed the quality of each trial.. Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis.. Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Clarithromycin; Contact Tracing; Erythromycin; Erythromycin Estolate; Erythromycin Ethylsuccinate; Humans; Infant; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Clarithromycin; Drug Administration Schedule; Drug Therapy, Combination; Erythromycin; Humans; Infant; Meta-Analysis as Topic; Patient Compliance; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Whooping cough is a highly contagious disease. Infants are the population at highest risk of severe disease and death. Erythromycin for 14 days is recommended for treatment and contact prophylaxis but this regime is considered inconvenient and prolonged. The value of contact prophylaxis is uncertain.. To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough.. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004); MEDLINE (January 1966 to February 2004); EMBASE (January 1974 to August 2003); conference abstracts and reference lists of articles were searched. Study investigators and pharmaceutical companies were approached for additional information (published or unpublished studies). There were no constraints based on language or publication status.. All randomised and quasi-randomised controlled trials of antibiotics for treatment of and contact prophylaxis against whooping cough were included in the systematic review.. At least three reviewers independently extracted data and assessed the quality of each trial.. Twelve trials with 1,720 participants met the inclusion criteria. Ten trials investigated treatment regimens and two investigated prophylaxis regimens. The quality of the trials was variable. Results showed that short-term antibiotics (azithromycin for three days, clarithromycin for seven days, or erythromycin estolate for seven days) were equally effective with long-term antibiotic treatment (erythromycin estolate or erythromycin for 14 days) in the microbiological eradication of Bordetella pertussis (B. pertussis) from the nasopharynx. The relative risk (RR) was 1.02 (95% confidence interval (CI) 0.98 to 1.05). Side effects were fewer with short-term treatment (RR 0.66; 95% CI 0.52 to 0.83). There were no differences in clinical improvement or microbiological relapse between short and long-term treatment regimens. Contact prophylaxis (of contacts older than six months of age) with antibiotics did not significantly improve clinical symptoms or the number of cases that developed culture positive B. pertussis.. Antibiotics are effective in eliminating B. pertussis from patients with the disease, rendering them non-infectious, but do not alter the subsequent clinical course of the illness. Effective regimens include: three days of azithromycin, seven days of clarithromycin, seven or 14 days of erythromycin estolate, and 14 days of erythromycin ethylsuccinate. Considering microbiological clearance and side effects, three days of azithromycin or seven days of clarithromycin are the best regimens. Seven days of trimethoprim/sulfamethoxazole also appeared to be effective for the eradication of B. pertussis from the nasopharynx and may serve as an alternative antibiotic treatment for patients who cannot tolerate a macrolide. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Clarithromycin; Contact Tracing; Erythromycin; Erythromycin Estolate; Erythromycin Ethylsuccinate; Humans; Infant; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Bordetella pertussis is the primary agent of the acute respiratory disease pertussis. It has been reported that the disease has recently become more common, especially in adults and adolescents, and adaptation of the pathogen is thought to have an important influence on the recurrence of the disease. This study aims to determine the effect of erythromycin, azithromycin, and trimethoprim-sulfamethoxazole used in the treatment of pertussis on the virulence gene expressions (prn, ptxS1, fhaB), biofilm-forming and growth of B. pertussis. In this study, the minimum inhibitory concentration (MIC) values of azithromycin and erythromycin in B. pertussis local strain Saadet were determined to be 0.09 μg/mL and 0.3 μg/mL, respectively. However, the Tohama-I and Saadet strains were resistant to trimethoprim-sulfamethoxazole (MIC>32 μg/mL). The biofilm-forming of the Saadet strain decreased with the increase in antibiotic doses. It was observed that 1/32MIC erythromycin and 1/32MIC azithromycin upregulated the expression of fhaB in Tohama-I, whereas the expression of ptxS1 and prn significantly decreased in sub-MICs of erythromycin. In the Saadet strain, only ptxS1 was highly expressed at 1/16MIC azithromycin and erythromycin (p > 0.05). This is the first study to investigate the effect of sub-MIC antibiotics on the expression of virulence genes and biofilm-forming of B. pertussis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Biofilms; Bordetella pertussis; Erythromycin; Gene Expression; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

The aim of the study was to determine trends in the minimum inhibitory concentrations (MICs) of erythromycin used as first-line therapy and alternative antibiotics against Bordetella pertussis (B. pertussis) strains isolated from patients with whooping cough in the Czech Republic (CR) in three periods from 1967 to 2015.. In total, 135 isolates from the years 1967–2015 were analysed. The strains were divided into three groups by the year of isolation: 1967–1999 (42 strains), 2004–2010 (43 strains), and 2011–2015 (50 strains). MIC of selected antibiotics (erythromycin, clarithromycin, azithromycin, ciprofloxacin, and trimethoprim/sulfamethoxazole) were obtained by the reference agar dilution method on Bordet Gengou Agar with 15% defibrinated sheep blood.. The study set included 70 strains previously tested for MICs of erythromycin and four other antibiotics. In the three study periods, the MICs of the tested antibiotics for B. pertussis were nearly identical. All but a single strain, inhibited by erythromycin at a concentration of 0.03 mg/l, were inhibited by two concentrations of erythromycin and azithromycin (0.06 and 0.125 mg/l). Clarithromycin inhibited the strains from all three study periods at the following concentrations: 0.03, 0.06, and 0.125 mg/l. Any of the 135 strains was inhibited by ciprofloxacin at a single concentration of 0.06 mg/l and by trimethoprim/sulfamethoxazole at three concentrations (0.125, 0.25, and 0.5 mg/l).. The study set of 135 Czech strains of B. pertussis isolated in 1967–2015 appears to be homogeneous in terms of the MICs for five antimicrobials. The MICs remained in a narrow range of two to three low concentrations; the unimodal distribution of the MICs suggests the absence of resistance mechanisms. The highest MICs of erythromycin, clarithromycin, and azithromycin were equally 0.125 mg/l, that of ciprofloxacin was 0.06 mg/l, and that of trimethoprim/sulfamethoxazole was 0.5 mg/l. Over the study period of 55 years, the MICs of the study antibiotics remained in the same ranges.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Ciprofloxacin; Clarithromycin; Czech Republic; Erythromycin; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough; Young Adult

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Erythromycin; Fluoroquinolones; Humans; Infant; Microbial Sensitivity Tests; RNA, Ribosomal, 23S; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Topics: Anti-Bacterial Agents; Bordetella pertussis; Drug Resistance, Bacterial; Epidemiological Monitoring; Humans; Microbial Sensitivity Tests; Ontario; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

We describe a case of nosocomial maternal transmission of Bordetella pertussis to a very-low-birth-weight (VLBW) neonate in whom treatment was unsuccessful. This case underscores the need for rapid and sensitive PCR diagnosis in VLBW neonates and in parents with clinical signs of pertussis and suggests that standard treatment may not be appropriate for VLBW neonates.

Topics: Anti-Bacterial Agents; Azithromycin; Cross Infection; Diphtheria-Tetanus-acellular Pertussis Vaccines; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Josamycin; Male; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Topics: Bordetella pertussis; Cough; Diagnosis, Differential; Disease Progression; Erythromycin; Humans; Infant; Lymphocytosis; Male; Microbial Sensitivity Tests; Nasopharynx; Respiratory Insufficiency; Respiratory Tract Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

To describe methods of preventing nosocomial pertussis in patients, employees, and visitors to a hospital during a communitywide epidemic in Greater Cincinnati.. Six-month descriptive study of the methods, effectiveness, and cost of a program to prevent nosocomial pertussis.. Three hundred sixty-one bed, tertiary-care, university, pediatric hospital.. We educated 3,764 hospital employees about pertussis. We evaluated 206 employees with respiratory illnesses, based on clinical presentation, pertussis exposure, and work setting. Eighty-seven had pertussis: 84 coughed for > or = 2 weeks (outbreak clinical case definition), 65 had paroxysms, 27 whooped, 22 had posttussive emesis, and 13 were positive by direct fluorescent antibody or culture for Bordetella pertussis. Seventy-nine employees were sent on 5-day furloughs. Six hundred twenty-two employees received 14 days of erythromycin (579) or trimethoprim-sulfamethoxazole (43). Symptomatic patients were identified at triage in the emergency department and placed in respiratory isolation. Suspect pertussis cases were admitted in respiratory isolation. Among 49 toddlers who were given erythromycin and managed in "coughing respiratory cohorts," eight had proven pertussis. Inpatients were restricted to assigned nursing units. Respiratory masks were required for those entering the test referral center, where more than 3,500 pertussis cultures were performed. Hospitalwide visitor restriction was enforced for those aged 14 years or younger and for those with respiratory symptoms. Only parents and guardians were permitted to visit the newborn intensive care unit. A child-care service managed 488 inpatient sibling visitors. Four symptomatic children in the employees' child-care center were excluded pending physician evaluation; one had pertussis.. Control measures appeared effective. Pertussis occurred in 87 (2%) employees. Among 102 children hospitalized with pertussis, respiratory isolation was delayed in nine cases, and one case was nosocomial. Program expenses totalled $85,400. Adult booster immunization with acellular pertussis vaccine might represent the safest and least expensive strategy for preventing epidemic pertussis, and controlled trials of acellular pertussis vaccine in hospital employees are needed.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Cross Infection; Disease Outbreaks; Erythromycin; Female; Hospitals, Pediatric; Hospitals, University; Humans; Infection Control; Male; Masks; Middle Aged; Ohio; Patient Isolation; Personnel, Hospital; Population Surveillance; Trimethoprim, Sulfamethoxazole Drug Combination; Visitors to Patients; Whooping Cough

We compared the ability of erythromycin and co-trimoxazole in clearing Bordetella pertussis from the nasopharynx of 22 children admitted to hospital with whooping cough. Both agents appeared effective. Nevertheless, 10 of the 22 patients gave positive cultures four or more days after antimicrobial administration was begun.

Topics: Bordetella pertussis; Child, Preschool; Drug Combinations; Erythromycin; Female; Humans; Infant; Male; Nasopharynx; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough