pertussis treatment, erythromycin versus azithromycin

[xyzParticipant]

prep 2009 answer that pertussis treatment is azithromycin but my references answer is erythromycin. Does anyone knows what ABP wants as answer?

 

 

• This topic was modified 12 years, 7 months ago by  ashish.

[ashishMember]

Good question. It’s surprising that it says something different than what the CDC recommends.

I know what I would choose, but what were the answer choices and rationale on the PREP question?

[egParticipant]

i saw that same question referred to by “xyz”…azithro and clarithro are preferred over erythro given lower s/e profile and easier dosing (esp with azithro)…per PIR 2012;33:412 (this is not referenced in this year’s PREP Study Guide – an article related to varicella is – not sure about that!) – see below excerpt:

“For many years, the standard regimen for the treatment of pertussis in children has been administration of oral erythromycin. Recent studies have demonstrated equal efficacy and improved tolerability of other macrolides, such as azithromycin. (8) Azithromycin is associated with fewer adverse gastrointestinal events, may be dosed once daily, and does not inhibit the cytochrome P450 system, and therefore may be preferable. In addition, erythromycin has been associated with an increased risk of pyloric stenosis when administered to infants in the first 2 weeks after birth. (9)”

[bdigParticipant]

http://www.cdc.gov/pertussis/clinical/treatment.html

 

That’s the CDC’s link.  I read the emedicine recs, but they are based on studies from ’96 and ’82.  Practically speaking, I have never used erythro in practice.  The motility SEs of erythro are not pleasant, and it’s 4x daily.  Yikes.

TBH, I seriously doubt that the ABP would offer both erythro and azithro as answer choices.

[ashishMember]

I agree with bdig, it’s VERY unlikely that they’d create such a controversial set of answer choices. They really don’t want to hear from hundreds of angry pediatricians.

Having said that, here are some additional thoughts:

1. If the child is < 1 mo of age, choose Azithromycin. Good consensus for this given the risks of pyloric stenosis

2. If the child is 1 – 6 mo of age, use “any macrolide.” Keep in mind that azithromycin and clarithromycin aren’t FDA approved for children less than 6 mo of age. I’d choose erythromycin

3. If the child is 6 mo or older, flip a coin. Compliance or reliability issues? Family history of pyloric stenosis? ANY other reason to avoid erythromycin? Choose Azithromycin.

but… I seriously doubt they’d make you choose. You’d probably only be given one macrolide choice.

hope that helps,

– ag

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