line drawing of doctor and patient using stethoscope

Treatment of whooping cough

This is a long page and the information you seek is probably on it somewhere, even if you have to follow a link

Very young babies need treating in hospital as it is very serious for them. More detail below.

Everyone asks about antibiotics. They are commonly used but do not cure it. They may prevent it getting worse and will stop it being infectious. More detail below.

Antibiotics can prevent transmission

If taken during the incubation period an antibiotic should prevent it developing.

The bacteria that cause whooping cough are present for about 3 weeks from the start of symptoms.

Therefore antibiotics are usually prescribed in the first 3 to 4 weeks to stop it being passed on. They will not cure it or alleviate it… more in my blog about it.

The most suitable antibiotics are erythromycin, clarithromycin or azithromycin. Co-trimoxazole is a second choice. Some far eastern countries have reported resistance to erythromycin in some strains.

Which antibiotic to use and the correct dosages can be seen in the Role of antibiotics in whooping cough page .

Whooping cough is very dangerous for babies

For very young babies whooping cough is a dangerous illness. They can die from pneumonia, respiratory failure and encephalopathy thought to be caused by pulmonary hypertension resulting from the effects of the toxins produced by the bacteria.

Supportive measures with rehydration, oxygenation and sometimes ventilation are vital considerations in sick infants. Such cases would necessarily be in hospital. Babies over 6 months old are generally less seriously affected and these measures may not be required unless some complication had set in.

A recent analysis of babies with whooping cough in the USA showed that the use of steroids (previously though helpful) was associated with a worse outcome.

It is to protect babies that we have an immunisation program. It is very effective in that respect.

Some infants and older children may also be more at risk if there are other underlying medical problems.

 

In older children and adults it is unpleasant but not life threatening

For the average case of whooping cough in older children and adults there is no treatment likely to make a difference to the course of the illness or reduce the symptoms. It will generally take its course no matter what. Attempts to get benefit from bronchodilators, cough suppressants or antibiotics are generally futile. 

It should be noted that in the developed world one would not expect more than 1% of cases (with the exception of infants) to require hospitalization because most cases are mild.

The Cochrane organisation, respected for evidence based objectivity has reviewed papers on reducing cough symptoms and found no evidence of benefit from several methods that were attempted, including steroids and bronchodilators. They conclude that more and better research is needed. See the report here.

More serious if complications like secondary infection occur

Another exception to the general non-seriousness is when complications occur. This is also quite rare and probably affects about 1% or 2% of cases in the developed world. The most frequent complication is pneumonia which requires standard antibiotic treatment. 

Some patients get a secondary infection of bacterial tracheo-bronchitis causing increased cough and sputum which may improve with antibiotics. 

The best authoritative advice on the management of pertussis. (NICE)

More information on whooping cough treatment. The UK authoritative body, the Institute for Health and Clinical Care Excellence (NICE), has published a Clinical Knowledge Summary on whooping cough. This organisation reflects the best evidence based management for doctors in the United Kingdom of Great Britain and Northern Ireland (Pop. approx. 60 million). I regard this document as the gold standard for management of pertussis. Most of the advice can be applied effectively in most developed countries, most of which do not have such a respected overriding authority.

The New Zealand Department of Health has excellent information on management of pertussis for health professionals.

There is also advice for health professionals issued by Public Health England which is extremely detailed with full explanations of all aspects of management with references. This is PHE’s up to date 2018 pertussis advice  on their website. If you want to know what UK doctors should be doing in the case of suspected pertussis, all the answers are here.

High dose vitamin C

There is one particular doctor in the USA who advocates high dose vitamin C to treat the cough. The claim is not supported by good quality trial data. I have had several emails from sufferers who have tried it and who report excellent and rapid improvement.

I would like it to be true, but like most such claims, you never hear about the failures or the longer term results, so a big question-mark remains. I am keen to hear more about success or failure of this substance from people who have personal experience of it.


Management of whooping cough

When there is no effective whooping cough treatment what remains to be done is management. For babies and children this will be mainly comforting during an attack and reassurance that it will soon pass and they will be fine. Back patting is not going to help but holding and stroking might. If vomiting occurs it is good to be leaning forward or face down if reclining so vomit falls away from the lungs.

Babies may need refeeding after vomiting

Babies who vomit may need refeeding and so might older children. It is common for children to lose weight with whooping cough and is more serious for babies.

Babies should not be left alone

Babies should not be left alone when they have whooping cough, even at night, so that problems do not go undetected. This also applies to older children until they can indicate they don’t want that, by which point they should be out of any danger.

Medical checks at appropriate intervals

It should be standard practice for sufferers to be checked by a doctor at least once. Even if it is not diagnosed, such a bad cough  needs a doctor’s examination. A competent doctor will arrange for some investigation of blood, or nasal, or oral fluid if whooping cough is suspected. 

It is a notifiable disease and efforts should be made by the doctor to confirm it. You cannot expect a doctor to test for it if it is not suspected to be the cause. Which test is done will depend on the service available to the doctor. 

Note again my advice to capture a paroxysm on your smartphone to assist your doctor with diagnosis

Sufferers should be removed from the presence of other people when they have an attack of coughing or they should remove themselves. Adults generally do that anyway. This is to reduce transmission. Going outside is even better.

Any general deterioration, particularly if it includes fever or breathlessness needs a medical check for complications such as pneumonia

Women may well find they leak urine during an attack. This can only be managed by using pads but will clear up when the whooping cough has cleared.

Avoid contact with babies and anyone in late pregnancy

It is vital to keep away from pregnant women in the last half of pregnancy and from children until they have had their primary shots, usually finished at about 4 months, unless you have been told you are no longer infectious.


Tips from patients

‘Christabel’s Method’. I have had lots of feedback that this has been useful to many people

A physiotherapist has emailed me an anecdote that I am inserting below. I have had lots of feedback that this is very helpful for many people. “We have named the following technique Christabel’s method after my daughter (9) as she noted that by attempting to stop herself from inspiring reflexively between coughs she could reduce the length and the violence of the cough and prevent reflux. 

Simply put she delays herself breathing in and holds what breath she has left for as long as possible then tries to breath slowly. This technique may not work on the first cough of the series but in our experience appears to slow down subsequent coughs. 

The techniques requires practice but does allow the patient some control back in their bodies! As this method requires the patient to overcome their natural reactions I suspect this is only suitable for older children and adults.”

Thickening liquids claimed to help

Many sufferers of whooping cough find that eating or drinking certain things provokes a coughing spasm. I have been passed anecdotal information from A.H., a paediatric speech and language therapist in the UK who has suggested that some coughing spasms may be due to liquid nourishment leaking past the vocal cords into the windpipe. The theory being that whooping cough might be causing some weakness of the vocal cords (it certainly can cause voice changes). 

I understand that she has found that thickening liquids before drinking can help this problem. Liquids should be thickened to the consistency of syrup before drinking, using a proprietary thickening agent that can usually be obtained from a pharmacy. 

One such product that should be easily available is ‘ThickenUp® Clear’, made by Nestle. 
If you suspect liquids are provoking some coughing, this is probably worth a try. 
September 2015
I have had no feedback on this which has supported its usefulness.

Placing forehead or cheek against something cold

One person I know found this stopped a paroxysm coming on.

Review

This page has been reviewed and updated by Dr Douglas Jenkinson 26 November 2020