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Role of antibiotics in whooping cough

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It is generally agreed that the best antibiotics to kill Bordetella pertussis, the causative organism, are the macrolides. The basic one is erythromycin but it often causes nausea. If it is given while the disease is incubating, it is believed it can stop it developing. This can be a vital protection for unimmunized infants who have possibly been exposed. If it is given when symptoms have started it seems to have no effect on the course of the illness. It will, however, kill the bugs and stop the victim passing it on to others. Otherwise patients can remain infectious for three weeks or even more. After 48 hours on the antibiotic it is now considered to be safe to allow the patient to mix with others again. It is normal practice to use a seven day course of erythromycin. Azithromycin for 3 days is considered tolerated and preferable. Under 1 month of age clarithromycin should be used. In patients intolerant of macrolides, co-trimoxazole is an effective alternative. Infections or pneumonia occur then these need to be treated with the antibiotics appropriate to these conditions.