- What is whooping cough (pertussis)?
- What is pertussis vaccine?
- Pertussis treatment. How to treat whooping cough?
- Can you get whooping cough more than once?
- Whooping cough treatment at home
- Whooping cough antibiotics
- Stages of pertussis
- Cure for whooping cough in adults
- Treatment of whooping cough in babies (infants)
- How to cure whooping cough with Azithromycin (Zithromax)? Dosage
What is whooping cough (pertussis)?
A whooping cough is a severe bacterial infection that has claimed many lives as a result of epidemy at the beginning and in the middle of XX century. This is very catching airborne infection. Moreover, it is possible to get infected both from an infected person, and a carrier. The endemic vaccination against the whooping cough implemented in 60s of the XX century has helped to significantly reduce the spread of an infection and a death of patients.
In spite of this, according to the official statistics of the WHO, more than 140 000 cases of the whooping cough infection have been recorded in 2015. The infection lead to 89 thousand deaths. However, the official statistics does not count many regions, and therefore there were about 25 million infections with the pertussis in the world according to the sociological studies.
A high mortality of the whooping cough is explained by the fact that the disease often affects children at the age of under 14 who have a decrease in immunity and a high vulnerability to the disease. Contacting a sick person, a risk of the infection of a child without vaccine is about 70-90%.
What happens during infection contamination:
- A germ of the whooping cough is Bordetella pertussis bacteria.
- Reaching the body, the germ of the whooping cough affects the mucus of the respiratory tracts and induces a severe spasm of bronchi.
- The frequent spasms of bronchi induce a severe irritation of the nerve centers that are responsible for coughing. As a result, a patient has prolonged and exhausting attacks of cough.
- The irritation of the airway tracts and bronchi grows during the attack of coughing, and so bronchospasm and a respiratory arrest occur.
- The respiratory arrest is a cause of death in 90% of the cases. This is the most dangerous complication that occurs during the neglected treatment of the whooping cough.
It is rather simple to detect a severity of the disease. A patient should be followed and a number of the cough attacks should be calculated a day:
- Stage 1: from 10 to 15 attacks of cough a day;
- Stage 2: from 15 to 25 attacks of cough a day;
- Stage 3 (the severest and the most dangerous one): from 30 to 60 attacks of cough a day.
A patient is prescribed an individual treatment depending on the disease severity and a general clinical presentation.
What is pertussis vaccine?
A pertussis vaccine appeared in 1926 but it was actively used in the middle of XX century after all clinical tests. As of today, the vaccine belongs to the list of the obligatory ones, just like a vaccine against diphtheria and catalepsy. According to the official statistics of WHO, the mass vaccination of children has helped to prevent about 700 thousand deaths within the past 20 years.
Nowadays there are two types of the vaccines against whooping cough:
- whole-cell vaccines;
- acellular vaccines.
Their efficacy is approximately similar, about 70-80%. But the biggest problem is that the efficiency of the vaccine gradually drops. So, children are recommended to have two vaccines: at the age of 2-4 months and 10-12.
On the average, the vaccine loses 65% of its efficacy within 12 years. But adults have a lighter course of the disease, and it seldom leads to death. In spite of this, the Centers for Disease control and Prevention recommend adults to have vaccines against the whooping cough too.
The matter is that adults may become a carrier of the infection and give it to children with weak immunity. This is one of the reasons why the whooping cough is often developed in the nursery schools, and schools, when teachers are a carrier and infect children.
A low efficacy of the pertussis vaccine is explained by a mutation of bacteria but in this case, a human could have the whooping cough many times within a life but it does not happen. We will talk about this later on.
Despite a low efficacy of the vaccine, do not underestimate its significance. If the disease occurs after the vaccination, the whooping cough is light. The symptoms are softer, and if the in-time treatment is started, the attacks of the cough do not go to the second stage and the disease quickly passes. This fact is confirmed by the death rates – just 0,07 per 100 thousand population. These rates have been by 100 times higher before the mass vaccination of the population in the world.
Pertussis treatment. How to treat whooping cough?
If the disease got you, it is necessary to start the treatment as soon as possible. But at first, you should make sure that it is the whooping cough. The incubation of the disease lasts from 1 to 2 weeks. Light coughing and symptoms of a cold appear during this period: fatigue, increase of the body temperature, sore throat, and difficult swallow.
But there is a chance that dry cough remains within 2 weeks. Pay attention that coughing may have a special pattern. A child does not cough for a while, and then he/she coughs within several minutes during the attack.
The most dangerous period begins in 2 weeks. It is accompanied by severe symptoms: severe uncontrolled cough is manifested in the form of the prolonged attacks. A patient may have lack of oxygen during the cough, red face, and veins may be swollen on the face and neck. It is better to detect the disease at the initial stage. In this case, a development of the complications is avoided with the help of the antibacterial therapy.
But as the disease usually takes a long period, the disease can be unpredictable even during the use of the antibiotics, and so patients need admission.
The therapy of the whooping cough is always complex and includes diet, and pharmaceutical administration. The prescribed drugs are aimed to:
- arrest the activity of the pathogenic organisms;
- reduce the frequency and severity of the cough attacks;
- relieve the consequences of hypoxia for the body;
- prevent a development of the complications including the development of the respiratory distress.
A complex pharmaceutical therapy is always used for these purposes:
- Antibiotics (macrolides, cephalosporin agents, penicillin) to defeat infection and an inflammation of the airways tracts;
- The anticonvulsive drugs to reduce the irritation of the coughing center in the brain and remove a tension from the nervous system.
- Vitamin-mineral complex to improve the immunity and for faster recovery.
If the intensity of the cough is kept and is not reduced within 1-2 weeks, a termination of the antibiotic administration and a prescription of glucocorticosteroids is possible.
Also, physiotherapeutic procedures, massages, oxygen therapy, sucking off mucus from the upper airway tracts are obligatory in medical settings in order to reduce a risk of the respiratory failure.
It is rather difficult to neutralize the action of bacteria. The biggest complication consists in a recovery. The matter is that it is rather difficult to restore their normal work and arrest the symptoms during the irritation of the nervous centers which are responsible for coughing. That is why, the active phase of the treatment takes just 40-45% and the recovery period – 55-60%.
Can you get whooping cough more than once?
A clinical presentation of the whooping cough is questionable. We have mentioned that vaccine against the whooping cough gives the protection for 12 years, and then it loses its efficacy by 65%. Scientists assume that the immune system is also able to resist the infection within identical period. Due to this reason, it is believed that if a person had the whooping cough once, this person can get infected again in some period. However, the disease will have a light course.
But another group of scientists states that there is the immunity against the infection developed after coming through an illness. The studies do not give an exact answer to this question because there are different cases in the clinical practice. There are cases when a person got the whooping cough in 5-6 years after the first infection. And it happens that the disease affects the airways tracts in 20 years. So if you had the disease as a kid, it does not mean that you will not have it in 30 years. Honestly, the chances are low but they are still there.
The bottom line is the immune system of a human. If it is able to resist infections, it does not matter how old you are and whether you have had the whooping cough.
Whooping cough treatment at home
Doctors insist on hospitalization during the whooping cough but there are light types of the disease that may be treated at home. A peculiarity of the home-treatment is a simple observance of the dietary regimen and the therapy may be intensified by old wives remedies.
A patient needs long walks without contacting other children during the treatment at home. The optimal temperature for walks is -5 to +15°C. Do not go for a walk during -10°C. The air should be fresh and moistened in the room where a patient is. Special humidifiers may be used. The moist air relieves the attacks of the dry cough.
A patient should avoid physical exercises and psychoemotional loads during the treatment. Stress, mood swings, or excitement are triggers for the cough attack. Food should not irritate throat and mouth cavity. It should be warm. Soft food is good, it should be easily swallowed.
Teenagers should avoid spices, fizzy drinks, sweets, peanut, and ice-cream. A patient is fed with small portions, and usually between the attacks.
Antibiotics are effective at the initial stage of the treatment when there is an initiating agent – an infection.
When the disease slightly recedes but the cough is kept, natural products are the most effective that can be cooked at home:
- Add 5 drops of the almond oil to 10 drops of onion juice and 10 drops of ginger juice. Take it 3 times a day within 2 weeks.
- Clover tincture. Add 400 ml of water to 3 tablespoon of clover, soak for 6-8 hours, and then filter it. Take 100 ml 4 times a day.
- Juice of garlic with honey. Garlic is one of the most effective products for the whooping cough. The garlic juice (with honey) should be taken in the amount of 5 drops to one tea-spoon depending on a child’s age 2-3 times a day during frequent and severe cough.
- Garlic with milk. Cut 5 garlic cloves into small pieces, boil it in a glass of raw milk. Give it to a child in the dose of one tea-spoon every hour within a day.
- Compress with garlic-honey mixture. Take several big garlic cloves and blender it. Add some honey and mix it. This mixture should be steamed, and then it is applied to the chest. A patient should be wrapped around with a warm scarf and covered with a blanket. The mixture is left for night. Repeat the procedure within several days.
Whooping cough antibiotics
It has been detected during twelve clinical studies where more than 1700 people took part that the best antibiotics for the treatment of the whooping cough are Zithromax (Azithromycin), Erythromycin, and Clarithromycin.
As pertussis has an infectious origin, the antibacterial therapy is the essential method of the treatment. However, the antibiotics can stop the disease and reduce a spread of the infection among other people. But the studies show that it is rather difficult to stop the clinical symptoms with the help of the antibiotics.
To treat the whooping cough, it is good to take the drugs of the new generation to which the infection does not have a resistance. Moreover, a drug of the choice is a medication that better acts in the airway tracts. So, macrolides are preferred.
The most effective schemes of the therapy are as follows:
- Three-day-therapy with Zithromax (Azithromycin);
- 7 or 14-day-therapy with Erythromycin;
- 7-day-therapy with Clarithromycin.
Also, there is data about the efficacy of a week-therapy with the antibiotic Co-trimoxazole but its results are worse than macrolide’s. That is why, it is a drug of the choice if a patient cannot take macrolides.
The antibacterial therapy lasts till the laboratory blood tests show a complete arrest of the pathogenic organisms. It usually happens within a week. The cough attacks are not a sign to take the antibiotics. The clinical studies may be kept within a long period after killing the infection activator, and they need another treatment.
Stages of pertussis
As we have said, there are 3 stages of the disease development that have their own symptoms. Every stage needs a special treatment, and one and the same method cannot be applied at all three stages.
And now, let's talk about stages of pertussis:
1. Catarrhal period
This is the initial stage of the whooping cough when bacteria are actively developed in the respiratory system and induce an inflammation of the respiratory tracts. The first symptoms of the pertussis may look like a common ARVI with the high body temperature and a cough. But perhaps the cough is going to be the only symptom during this period: dry, obsessional and not treatable by any products.
- This period lasts from 4 to 7 weeks in children at the age of 2 months to 2 years;
- This period lasts from 1 to 2 weeks in children at the age of 2 to 14 years.
If the disease has been detected during this period, a patient is prescribed antibiotics. It is the essential way to stop the infection development.
2. Spasmodic period - a peak of the disease
It is the severest period for a patient and people around him/her. The cough during the pertussis becomes attack-like, continuous, and is hardly arrested. A range of the cough impulses happens during the exhale and ends with a sharp sibilant inhale in the classical option, as it is described in the books.
Now the classical symptoms are different than it has been 20-30 years ago: a patient inhale deeply, and a new attack of the cough begins. It may be from 3 to 8 times during one attack.
- This period may take from 2 to 12 weeks depending on the efficiency of the therapeutic procedures.
This cough significantly worsens the quality of the life and may lead to the development of the muscular pain in the area of the chest, spitting up blood, vomiting, and urinary incontinence. Also, diaphragmatic and other types of hernia often appears during this period.
The administration of the antibiotics is pointless during this period because an infection does not replicate anymore. There is a point to add antibiotics to the therapy, if the disease is complicated by pneumonia. Then it is necessary to use symptomatic treatment.
The exhausting cough during the pertussis may last for 2-3 months. The frequency of the attacks is gradually reduced and the cough attacks are not spasmodic. The administration of the antibiotics is not required during this period.
The recovery stage is accompanied by the chronic cough that may be kept for up to 5-6 months. To improve the respiratory functions, patients are prescribed physiotherapeutic procedures. If the respiratory function has been affected during the spasmodic period, a patient is prescribed bronchodilators.
Cure for whooping cough in adults
The pertussis has a light course in adults. According to the statistics, about 30% of the adult patients do not even know that they are sick. The cough has a chronic character than spasmodic one. So, the symptoms of pertussis in adults are blurred, and doctors may suspect that this is ARVI. As the symptoms of the pertussis are light, adults do not need a special treatment.
In most cases, the treatment of the whooping cough in adults is done at home. But it is possible only if there is not close contact to a child, and a risk of the infection transmission is absent.
A peculiarity of the cure for whooping cough in adults consists in an administration of any antibiotic. So, adults are often prescribed a high dose of Zithromax (Azithromycin) within 3 days.
Besides the antibiotics, adults are also recommended to add vitamin-mineral complexes to the therapy, and the drugs to defeat the cough:
- Mucolytic drugs allow making begma less gluey, and this will relieve its discharge. Adults can do inhalations with medications from this group.
- Sedative antitussive medications inhibit the corresponding nervous center and prevent a formation of the chronic cough. In severe cases, adult patients are prescribed codeine (when the cough is dangerous and is accompanied by severe pain in the chest).
In general, the cure for the whooping cough in adults involves the prevention of the cough and an arrest of the infectious process. The immunity of the adult people copes rather well with an infection but there is a risk to transmit it to relatives. So, it is better to avoid contact with relatives, especially children at the age of under 16 during the first stage of the disease.
A patient has to spend more time in the open air at the moderate temperature. It is easy to do for an adult person because he/she can go to the park, or to the lake where the fresh and moist air is.
Also, adults are prohibited to consume alcohol and smoke during the treatment. Alcohol loads the central nervous system and it will induce the coughing center, and cigarettes are dangerous for the patients with the pertussis. If the cigarette smoke reaches the respiratory tracts, the acute bronchospasm and a respiratory arrest may occur.
Treatment of whooping cough in babies (infants)
Unlike adults, children (especially at the age of under 2) are more vulnerable to complications during the whooping cough. Therefore, a child should be sent to a hospital if the disease is suspected. We have talked about the vaccine, they are obligatory for children. But if the infection has happened, it is necessary to take measures as soon as possible.
Antibiotics for the treatment of the whooping cough in children are allowed during the stage 1 and 2. It is believed that Azithromycin does not do for children under 12, and so this drug is not prescribed. It is true.
So, to treat the whooping cough in babies, it is better to use penicillin: for example, Amoxicillin, or Augmentin. If the antibacterial therapy with penicillin does not give the results within 5 days, a baby is prescribed Zithromax (Azithromycin). A risk of the complications of the pertussis is higher than a potential risk of the side effects of Azithromycin.
A child is also prescribed:
- Bronchial spasmolytic increases the lumen of the bronchia and help to relieve the breathing;
- Mucolytic agents discharge the excessive mucus from the bronchi;
- Vasodilating agents improve the blood circulation in the lungs and brain, reduce a risk of the complications because of the lack of oxygen during the cough attacks.
A peculiarity of the pertussis treatment in babies consists in the fact that children are not given sedative drugs which come down the central nervous system. Due to this, it is recommended to use the natural remedies we have talked about earlier to cope with the cough in children.
There is no point to take the antibiotic for a long period. First off, an infection rather quickly dies, and the symptoms are kept for long. Secondly, the prolonged administration of the antibiotics may harm the immunity, and this will complicate the treatment of the whooping cough. So, if the cough spasms do not pass within 2-3 weeks, a child is prescribed glucocorticoids. These are hormone drug that are able to stop the cough spasms and affect the central nervous system.
As a rule, a prescription of the glucocorticoids is a last-ditch method. They have the side effects but this is the only way to defeat a severe type of the whooping cough.
A child should be prescribed the following medications during the hospitalizations:
- Oxygen therapy: the body gets the air saturated with oxygen by means of a special device;
- Nootropic agents: or drugs to improve the metabolism in the brain.
Children are vulnerable to the complications in the brain tissues because of the hypoxia. Therefore, pay attention to the general state of a baby. If the child's speech or movements become slow, or the baby is passive and anergic, ring the alarm.
How to cure whooping cough with Azithromycin (Zithromax)? Dosage
As we have already mentioned, the clinical studies have stated that Azithromycin (Zithromax) is the most comprehensive antibiotic to cure the whooping cough.
Its advantages are as follows:
- The treatment takes not more than 3 days.
- It has a minimal number of the side effects.
- It may be taken both before and after meals.
- It works for most patients.
A self-treatment is not recommended during the whooping cough, and therefore you will get recommendations how to take the antibiotic. But you have to be ready that the Azithromycin is taken before the doctor makes a diagnosis.
So, you must follow the instruction:
- Adults have to take 1 tablet Zithromax (Azithromycin) 500 mg 2 times a day (in the morning and evening);
- Take the tablets with warm water.
- Do not miss any dose in order to avoid the infection spreading through the respiratory tracts.
Before prescribing Zithromax for children, you should consult a doctor. Perhaps this drug will not do for your child. Bear in mind that the manufacturer recommends taking Azithromycin by patients at the age of over 12.
There are two working schemes of the use of Azithromycin for children. They do not differ by the efficacy, but the doses slightly differ:
1. Zithromax (Azithromycin) 10 mg per 1 kg the body mass a day, and then 5 mg per 1 kg body mass within the 2nd-5th days.
2. Zithromax (Azithromycin) 10 mg per 1 kg body mass a day (2 times) within 5 days (but not more than 500 mg/day).On the average, the differences in the doses are small but the first scheme better works for babies, and the second scheme works well for older children. Also, the first scheme contains a softer dose of Zithromax for children, and so it is well tolerated and has a lower risk to induce the side effects.