line drawing of dr and patient using stethoscope

Treatment of whooping cough

 

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

The most suitable antibiotics for whooping cough are from the macrolide family. Erythromycin, clarithromycin, azithromycin. Co-trimoxazole is a second choice.

If you have such an antibiotic while you are incubating the disease it may prevent it developing.

Prevent transmission

Many people with whooping cough are given an antibiotic such as azithromycin. This is to kill any Bordetella pertussis they may still carry so as to make it more difficult to pass it on to others. 

The conventional wisdom that authoritative websites all repeat is that after 3 weeks there is no pointing taking an antibiotic to reduce infectivity. The basis for a 3 week cut off is dubious because sufferers can still cough out live B. pertussis up to 5 and occasionally 6 weeks. 

There is also confusion about when to start week 1. Is it the start of illness or the start of coughing? They are different but authorities muddle the two. See my Blog on it.

It may be more sensible to give an antibiotic up to 5 weeks if there is a need to remove the risk of spread. After 3 days the individual can be assumed to be clear of infection.

The most suitable antibiotics are from the macrolide family. Erythromycin, clarithromycin, azithromycin. Co-trimoxazole is a second choice. There have been reports of macrolide resistance in China.

Which antibiotic and the correct dosage can be seen on the Role of antibiotics in whooping cough page.

Up to 3 weeks from the start of symptoms there is a slight possibility of reducing the eventual severity with antibiotics.

BUT, for the average case of whooping cough 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. Prevention by immunization is the best strategy.

The Cochrane organisation, respected for 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.

Babies are an exception

Supportive measures with hydration and oxygenation and sometimes with ventillation are vital considerations in sick infants. Such cases would obviously be in hospital. Babies over 6 months old are generally less seriously affected and these measures would not generally be required in others unless a complication such as pneumonia had set in. 

A recent analysis of babies with whooping cough treated in the USA showed that the use of steroids (previously thought helpful) was associated with a worse outcome. It should be noted that in the developed world one would not expect even 1% of cases (with the exception of infants) to require hospitalization because most cases are mild.

Or if complications like secondary infection occur.

Another exception is when serious complications occur. This is also 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.

For very young babies whooping cough is a dangerous illness and they can die from pneumonia, respiratory failure and encephalopathy thought to be caused by pulmonary hypertension. It is to protect babies that we have an immunization program, and it is effective. 

The best authoritative advice for  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.

 


Management

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.

Trustworthiness

This page has been reviewed and updated by Dr Douglas Jenkinson 20th September 2019

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