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Recommended oral antimicrobial treatment and postexposure prophylaxis for pertussis, by age group

Recommended oral antimicrobial treatment and postexposure prophylaxis for pertussis, by age group
Age group Primary agents Alternate agent*
Azithromycin Erythromycin Clarithromycin TMP-SMX
<1 month Recommended agent; 10 mg/kg per day in a single dose for 5 days (only limited safety data available) Not preferred; erythromycin is associated with infantile hypertrophic pyloric stenosis; use if azithromycin is unavailable; 40 mg/kg per day in 4 divided doses for 14 days Not recommended (safety data unavailable) Contraindicated for infants aged <2 months (risk for kernicterus)
1 through 5 months 10 mg/kg per day in a single dose for 5 days 40 mg/kg per day in 4 divided doses for 14 days 15 mg/kg per day in 2 divided doses for 7 days Contraindicated at age <2 months; for infants aged ≥2 months, TMP 8 mg/kg per day, SMX 40 mg/kg per day in 2 divided doses for 14 days
Infants (aged ≥6 months) and children 10 mg/kg in a single dose on day 1 (maximum: 500 mg); then 5 mg/kg per day (maximum: 250 mg) on days 2 through 5 40 mg/kg per day in 4 divided doses for 7 to 14 days (maximum: 2 g per day) 15 mg/kg per day in 2 divided doses for 7 days (maximum: 1 g per day) TMP 8 mg/kg per day, SMX 40 mg/kg per day in 2 divided doses for 14 days (maximum TMP 320 mg, SMX 1600 mg per day)
Adults 500 mg in a single dose on day 1 then 250 mg per day on days 2 through 5 2 g (base) per day in 4 divided doses for 7 to 14 days 1 g per day in 2 divided doses for 7 days TMP 320 mg per day, SMX 1600 mg per day in 2 divided doses for 14 days
TMP-SMX: trimethoprim-sulfamethoxazole (cotrimoxazole).
* TMP-SMX can be used as an alternative agent to macrolides in patients aged ≥2 months who are allergic to macrolides, who cannot tolerate macrolides, or who are infected with a rare macrolide-resistant strain of Bordetella pertussis. One double-strength tablet contains trimethoprim 160 mg with sulfamethoxazole 800 mg.
¶ A shorter course (ie, 3 days) of azithromycin for treatment or postexposure prophylaxis of B. pertussis has not been validated and is not recommended.
Data from:
  1. American Academy of Pediatrics. Pertussis (whooping cough). In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, 2021. p.578.
  2. Centers for Disease Control and Prevention. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis. 2005 CDC guidelines. MMWR 2005; 54:10.
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