Active substances: Amoxicillin
CDC-Recommended Regimens for Treatment of PID Oral Ofloxacin Floxin 400 mg orally twice daily for 14 days or levofloxacin Levaquin 500 mg orally once daily for 14 days; with or without metronidazole Flagyl 500 mg orally twice daily for 14 days Alternative: Ceftriaxone Rocephin 250 mg IM in a single dose or cefoxitin Mefoxin 2 g IM in a single dose with concurrent probenecid Benemid 1 g orally in single dose or other parenteral third-generation cephalosporin; plus doxycycline Vibramycin 100 mg orally twice daily for 14 dayswith or without metronidazole 500 mg orally twice daily for 14 days Parenteral Cefotetan Cefotan 2 g IV every 12 hours or cefoxitin 2 g IV every six hours; plus doxycycline 100 mg orally or IV every 12 hours Alternatives: Clindamycin Cleocin 900 mg IV every eight hours; plus gentamicin loading dose IV or IM 2 mg per kg followed by a maintenance dose 1.
Still, in older or immunized patients, some attenuation of symptoms especially of paroxysmal stage can be observed.
This atypical clinical course often results in the underdiagnosis or misdiagnosis of the disease in adults, as postviral cough, asthma, or chronic sinusitis.
The gold standard method for the establishment of the diagnosis is the isolation of the pathogen from cultured tissues or fluids, mainly nasopharyngeal swabs, aspirates, or washes.
Yet, several confounding factors can influence the reliability of the method, such as treatment with antibiotics, the stage of the disease, and previous vaccination history. A 4-fold increase in anti-PT IgG with 4—6-week intervals is probably the most reliable serologic test.
Notably, as happened in the presented case, leukocytosis is generally uncommon in adolescents, adults, and partially immunized children and even in the absence of it, the diagnosis of pertussis should not be excluded.
Antibiotic agents of choice for pertussis treatment are macrolides, such as erythromycin, clarithromycin, and azithromycin.
Appropriate antibiotic treatment can eliminate Bordetella pertussis from the respiratory tract and, consequently, prevent transmission to susceptible contacts.
Furthermore, it has been proved that antibiotics decrease the probability of secondary bacterial infections and reduce duration and severity of symptoms, when given early in the course of the disease.
Unfortunately, we were not able to document the exact timing of antibiotic treatment. Newborns are vulnerable to infection during the first weeks of their life, given that the quantity of maternal antibodies transferred is, in most cases, insufficient to provide protection.
Tdap boost vaccination for subjects older than 11 years is an effective prevention strategy and, therefore, should not be omitted.
Similar symptoms can be caused by other pathogens, as well, including adenoviruses, respiratory syncytial viruses RSV, human parainfluenza viruses, influenza viruses, Mycoplasma pneumonia, and rhinoviruses.
Coinfections, particularly with Bordetella pertussis and RSV, are commonly seen among infants. In adult patients, it is essential that the differential diagnosis of persistent cough should include primary and secondary pulmonary malignancies, and imaging with X-ray or Computed Tomography CT of the chest must be accordingly performed in these cases.
According to a government review published last year, at least 700,000 deaths globally are now caused by treatment-resistant infections, and that number is rising.
So what should patients do?
James Sutton was so ill he could hardly manage a flight of stairs and had been to the doctors twice before they agreed to give him antibiotics, and it was more than a week after he finished the course before he began to feel any better.
The mantra to always take the full course of antibiotics is well-known. Changing this will simply confuse people.