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PEDIATRICS Vol. 100 No. 1 July 1997, pp. 65-71

Seven Days of Erythromycin Estolate Is as Effective as Fourteen Days for the Treatment of Bordetella pertussis Infections

Received Sep 5, 1996; accepted Nov 5, 1996.

Scott A. Halperin*, Dagger , R. Bortolussi*, Dagger , Joanne M. Langley*, §, Barbara Miller*, and Brian J. Eastwoodparallel

From the * Departments of Pediatrics, Dagger  Microbiology and Immunology, and § Community Health and Epidemiology, Dalhousie University and the IWK-Grace Health Centre, Halifax, Nova Scotia, Canada, and the parallel  Department of Statistics, University of Auckland, Auckland, New Zealand.

Objective and Methods.  Although 14 days of erythromycin is recommended for the treatment of Bordetella pertussis infection, there have been no prospective controlled studies to support the contention that this long course of therapy is required to eradicate the microorganism from the nasopharynx or to prevent bacteriological relapse. We randomly allocated children and adults with culture-positive community-acquired pertussis to either 7 or 14 days of erythromycin estolate treatment (40 mg/kg/d; maximum dose 1 g/d). Nasopharyngeal aspirate cultures were obtained by study nurses during home visits before and at the end of treatment, and 1 week after the completion of treatment. B pertussis-specific antibodies were measured before treatment and 1 month later. Information about clinical symptoms, adverse reactions, and compliance were collected at each scheduled contact.

Results and Conclusions.  A total of 168 participants were eligible for analysis (74 treated for 7 days and 94 treated for 14 days). Bacteriological persistence (positive end of therapy culture) occurred once in each group, and bacteriological relapse (positive culture 1 week after completion of treatment) occurred in one participant treated for 7 days. The overall failure rate (persistence plus relapse) of 2.70% in the 7-day group was not different than the rate of 1.06% in the 14-day group. The study had a power of 99.99% at the 5% level to detect a difference in failure rates of 10% and a power of 80% to detect a difference of 5%. We conclude that 7 days of erythromycin estolate is as effective as 14 days for the eradication of B pertussis.

Key words: pertussis, whooping cough, Bordetella pertussis, antimicrobial therapy, erythromycin estolate.




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