Pertussis: Treatment, Cost and Side Effects

Pertussis is a bacterial infection caused by the bacteria Bordetella pertussis that is spread very contagiously via infected coughs and sneezes. The symptoms of the disease are mild in the intial stages and are coupled with only runny nose, cough and fever which are misled to be that of common cold. But these symptoms often go unchecked and the symptoms get aggravated to result in severe coughing fits followed by a whooping or gasping sound, thus, its name whooping cough.

The cough may last for more than 10 weeks and has also been known as 100-Days cough. The persistent hard coughing leads to vomiting and breaking ribs. In children, the symptoms are not visible as persistent coughs but they get periods of breathlessness. It takes about 7 to 10 days for the symptoms to be visible after the infection has taken place. So, the best way to keep pertussis at bay is getting vaccinated so that you experience less severe symptoms on infected and the other effective treatment for pertussis is using antibiotic therapy.

The stage of 3 stages of pertussis, which is also called whooping cough are:

Stage 1: The first stage of pertussis also called Catarrhal stage, lasts for about 1-2 weeks. During this time the symptoms of pertussis match with common cold thus it is contagious during this time.

Stage 2: The second stage, also called Paroxysmal stage is more severe than the first stage and violent coughing start in this stage. Along with severe cough people often have teary-eyes, salivate and gasp for breath. Due to coughing fits, vomiting and exhaustion can also take place. The second stage may last up to one-six weeks. But if it is severe then it may take 10 weeks to get cured.

Stage 3: The third stage is the end stage and is also called Convalescent stage. During this stage, cough starts to lessen and the cough no longer remains contagious. This stage lasts for up to 2-3 weeks.

Pertussis is a highly contagious and infectious respiratory disease. This is caused by the bacterium Bordetella pertussis and this can affect people of any age, especially children. Most probably it gets spread by coughing and sneezing. In rare cases, the condition can be fatal or sometimes serious also that the person needs to be hospitalized.

The symptom of pertussis is more likely to be like common cold which may include water-eyes, runny nose, tiredness, mild-occasional cough, and low-grade fever. At times the cough can also become severe and last for severe days. Symptoms of pertussis may include:

• Vomiting after cough
• Exhaustion after coughing
• Runny nose
• Fever
• Red and blue face
• Severe coughing which is at times followed by gasping of breath.

The main cause of pertussis or whooping cough is a bacteria called Bordetella pertussis. If a person with pertussis coughs or sneezes then the bacteria spreads from one person to another through the air, or water droplets.

Sometimes the diagnosis of pertussis at the early stages is difficult as the symptoms match with a common cold and it resembles like any common respiratory disorder. If the problem persist then you must visit the doctor who may recommend some medical tests which may include:

1. Blood tests: As the white blood cells help the body to fight against infection, a blood test is done to get the white blood cell count. If the number of white blood cells is more then there are chances that there is the presence of infection in the body.
2. Nose or throat culture test: A swab sample is taken by the doctor from the area where the nose and throat meet, called nasopharynx. Then the sample is tested if there is the presence of whooping cough bacteria or not.
3. X-ray of Chest: The doctor may recommend a chest X-ray to check that there is any kind of fluid present in the lungs or not. Which may sometimes cause whooping cough, pneumonia or any other respiratory disease.

The treatment for pertussis involves antibiotic therapy which is better if done early when the infection has started. Antibiotics are used to kill the bacteria present in the body. The treatment should be done as routine administering of the antibiotics. Antibiotics used for treating pertussis are Erythromycin, Azithromycin, Clarithromycin and Trimethoprim.

Erythromycin (EryPed, Erythrocin, Ery-Tab and E.E.S.) acts by inhibiting the bacterial growth. It does not allow the peptidyl transfer ribonucleic acid, that is, tRNA to dissociate from ribosomes in the cells. This thereby blocks the RNA-dependent protein synthesis. Erythromycin is prescribed to be taken orally as 50mg/kg/day 4 times a day for 2 weeks. The medication has been found to be quite effective if it is administered within first 10-14 days of the infection.

The mechanism of action of the antibiotics Clarithromycin (Blaxin) and Azithromycin (Zmax and Zithromax) is also similar and are also quite effective against the disease. Trimethoprim-sulfamethoxazole (Bactrim DS, Bactrim and Septra DS) antibiotic acts by inhibiting dihydrofolic acid synthesis thereby inhibiting bacterial growth. This antibiotic has usually been used as an alternative drug only and is mostly used in infants or as first-line agents in patients who are allergic to other antibiotics. Other more recently discovered macrolides are also used for treating pertussis.

The antibiotics can have some side effects like allergies. Erythromycin can have side effects like nausea, vomiting, upset stomach, anorexia, and hepatic dysfunction. Azithromycin can cause side effects which are not very serious like slight fatigue, insomnia, feeling nervous, mild rash, itching and discharge from the vagina or vomiting and constipation etc. Clarithromycin also has these less serious side effects which do not bother the patient too much.

The cost of treatment of pertussis in India ranges from Rs. 200 to Rs. 1,000 including medication and consultation fees.

Yes, the results of the treatment are permanent and will not occur on stopping the medication after the medication course is completed.

There is no alternative to the treatment if the disease is diagnosed after its first stage when the infection has increased to the degree when it requires only antibiotics to get relieved. But if the symptoms are perceived in the early stage then they can be managed using some simple home remedies like taking plenty of rest, drinking lots of fluids to keep hydrated, eat small meals and avoid vomiting after coughing, try to be in cleaner environment and avoid inhaling tobacco smoke.

Lifestyle and home remedies may also help in getting rid of pertussis, which may include:

• Getting plenty of rest: If you are suffering from pertussis then you must take plenty of rest and relax because whooping cough is exhausting.
• Eating smaller meals: You must eat smaller meals to avoid coughing and larger meals may lead to vomiting.
• Drinking fluids: Plenty of fluids must be drank at the time of pertussis as frequent may lead to dehydration, dry lips, and infrequent urination.
• Prevention of transmission: If you are suffering from pertussis then it must be taken care off and hands must be washed frequently and mask should be worn.
• Getting clean air: Home must be kept free from smoke, fumes, and tobacco as it may trigger coughing.