What is the role of antibiotics in whooping cough?

Antibiotics do not cure it or get you better faster unless taken in the incubation period or soon after.

New warning. A recent metanalysis study suggests a slightly increased risk of birth defects when macrolide (erythromycin family) antibiotics are taken in pregnancy, particularly in the first trimester. Risks need to be expertly judged before using in pregnancy.

Antibiotics are used to kill the bacteria that cause whooping cough when that is thought necessary. 

Although most authorities say there is no need for antibiotics after 3 weeks, some people keep coughing out live bacteria for up to 6 weeks from the start of symptoms. 

Knowing when it started can be quite difficult, so it may be better to give an antibiotic up to perhaps 5 weeks if the person is going to be in contact with others.

Erythromycin (a member of the macrolide family of antibiotics) is mostly used. A related antibiotic, Azithromycin is most popular because it is better tolerated  and requires a shorter course. Co-trimoxazole is an alternative (not in pregnancy). Erythromycin causes some people to vomit as a side effect.

After 3 days on an antibiotic the bacteria are believed to be  dead and you cannot pass it on.

Some people get a secondary infection on top of whooping cough, causing bronchitis with infected sputum and a productive cough. This may require antibiotics appropriate to whatever the infection is likely to respond to. 

Some children will get ear infection as a complication of whooping cough. This would require antibiotics.

Whooping cough sometimes leads to pneumonia. That will definitely need antibiotics and sometimes hospitalization too.

If erythromycin is taken in the incubation period it can stop whooping cough developing.

If erythromycin is taken when the symptoms are just starting it MAY shorten the illness.

Bordetella pertussis is NOT sensitive to amoxicillin so should not be used to treat whooping cough.

Remember that antibiotics can be detrimental to health by damaging the gut microbiome and encouraging antibiotic resistance. Use sensibly by seeking medical advice.

Details of antibiotic dosages for pertussis 

Taken from Public Health England’s ‘Pertussis brief for medical professionals‘ 2018

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