What is the preferred drug for whooping cough outbreaks?

Author: Dagui

Edited and compiled by Yimaitong, please do not reprint without authorization.

What is the preferred drug for whooping cough outbreaks?

Pertussis flares up

According to the National Bureau of Disease Control and Prevention: As of February 29, 32,380 cases of whooping cough have been reported across the country this year, nearly 23 times that of the same period last year, and 13 of them have died.

Figure 1: From Weibo hot search

Pertussis is an acute respiratory infection caused by the bacillus pertussis, which has a long course and can last for several months, so it is called pertussis. The latest pertussis regimen [1] recommends that macrolide antibiotics such as azithromycin, erythromycin, roxithromycin, or clarithromycin be the preferred choice. This article only summarizes the indications, dosage and precautions of macrolides for clinical reference.

Macrolides

Macrolides are weakly basic antibiotics produced by Streptomyces, named after the 14 or 16-membered ring in which the molecule contains a lactone structure, and erythromycin is the most typical representative of this class of drugs. Macrolides act on the 50s subunit of riboproteosomes in bacterial cells, hinder bacterial protein synthesis, and are growth stage inhibitors.

Antimicrobial tendon

Mainly gram-positive bacteria and some gram-negative cocci, including staphylococcus, streptococcus faecalis, meningococcal, anthrax, gonorrhoea, diphtheria, pertussis, clostridium aerogenes, brucella, campylobacter, legionella, leptospira, mycoplasma pneumoniae, rickettsia, chlamydia, etc.

peculiarity

1. Strong antibacterial activity in alkaline environment, alkalinization of urine is often required for the treatment of urinary tract infections

2. The blood concentration is low, the concentration in the tissue is relatively high, and the sputum, subcutaneous tissue and bile are significantly exceeded

3. It is not easy to penetrate the blood-brain barrier due to the blood concentration of the drug

4. It is mainly excreted through bile and carries out hepatoenteric circulation

5. The main side effect after oral administration is gastrointestinal reactions

6. Esterified erythromycin has certain hepatotoxicity, so it should only be used in small amounts and for a short time.

7. Tinnitus and hearing impairment can cause allergic reactions such as drug fever, drug healing, and nettle.

8. Due to local irritation, intramuscular injection is not advisable. Intravenous dripping can cause phlebitis, so the drip should be dilute and the drip rate should be slow.

9. It can inhibit the normal metabolism of theophylline, resulting in an increase in the blood concentration of theophylline and poisoning, and even death.

Azithromycin

Indications for oral formulations

1. Acute pharyngitis and acute tonsillitis caused by Streptococcus pyogenes.

2. Sinusitis, otitis media, acute bronchitis, and acute attack of chronic bronchia caused by sensitive bacteria.

3. Pneumonia caused by Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae.

4. Urethritis and cervicitis caused by Chlamydia trachomatis and non-drug-resistant Neisseria gonorrhoeae.

5. Skin and soft tissue infections caused by sensitive bacteria.

Dosage

Take 1 hour before or 2 hours after meals.

Pediatric dosage of azinomycin:

(1) For the treatment of otitis media and pneumonia, on the first day, take 10mg/kg of body weight (the maximum amount of a day does not exceed 0.5g), and on the 2nd ~ 5th day, take 5mg/kg of body weight daily (the maximum amount of a day shall not exceed 0.25g)

(2) For the treatment of pediatric pharyngitis and tonsillitis, take 12mg/kg of body weight a day (the maximum amount per day does not exceed 0.5g) for 5 days.

Azithromycin for injection

It is suitable for the following infections caused by susceptible pathogenic strains:

1. Community-acquired pneumonia caused by Chlamydia pneumoniae, Haemophilus influenzae, Legionella pneumophila, Moraxella catarrhalis, Mycoplasma pneumoniae, Staphylococcus aureus or Streptococcus pneumoniae that requires intravenous infusion treatment first.

2. Pelvic inflammatory disease caused by Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis requires intravenous infusion treatment first.

Dosage

10mg/(kg-times), fully mixed with 250 mL of 5% glucose injection, intravenous infusion was completed within 1~3h, once a day, and the drug was continued for 7~14d.

Clarithromycin

Indications

It is suitable for the following infections caused by pathogenic bacteria to which it is susceptible, including:

1. Lower respiratory tract infection: such as bronchitis, pneumonia, etc.

2. Upper respiratory tract infection: such as pharyngitis, sinusitis, etc.

3. Skin and soft tissue infections: such as folliculitis, cellulitis, erysipelas:

4. Local or diffuse infection caused by Mycobacterium avium or intracellular mycobacteria. Localized infection caused by Mycobacterium turtle, Mycobacterium incidentaris, or Mycobacterium kansas.

5. Clarithromycin is suitable for HIV-infected patients with CD4 lymphocyte count less than or equal to 100/mm3 to prevent mixed infection caused by disseminated Mycobacterium avium.

6. In the presence of gastric acid inhibitors, clarithromycin is also suitable for the eradication of Helicobacter pylori, thereby reducing the recurrence of duodenal ulcers

7. Treatment of odontogenic infection.

Dosage

Oral administration for children: 7.5 mg/kg for children over 6 months of age, once every 12 hours.

Or administer as follows:

Body weight 8~11kg, 62.5mg once, once every 12 hours;
Body weight 12~ 19kg, 0.125g once, 1 time every 12 hours;
Body weight 20~29kg, 0.1875g once, 1 time every 12 hours;
Body weight 30~40kg, 0.250g once, once every 12 hours;

Depending on the severity of the infection, it should be taken continuously for 5~10 days.

Medication precautions

1. Patients with severe impairment of renal function (creatinine clearance less than 30ml/min) must be adjusted in dose. The usual amount is 0.25g at a time,

1 time a day; For severely infected patients, the first dose is 0.5g, and the subsequent dose is 0.25g, twice a day.

2. Blood or peritoneal dialysis cannot reduce the plasma concentration of clarithromycin.

3. Clarithromycin is forbidden to be used in combination with the following drugs: astemizole, cisapride, pimoqite and terfenadine.

4. Pregnant and lactating women are prohibited.

5. Patients with severe liver impairment, patients with water and electrolyte disorders, and those taking terfenadine treatment are prohibited.

6. Patients with certain heart diseases (including arrhythmia, bradycardia, prolonged Q-T interval, ischemic heart disease, congestive heart failure, etc.) are prohibited.

erythromycin

Indications

1. As an alternative to the treatment of the following infections in penicillin-allergic patients:

Acute tonsillitis, acute pharyngitis, sinusitis caused by hemolytic streptococcus, Streptococcus pneumoniae, scarlet fever and cellulitis caused by hemolytic streptococcus, diphtheria and diphtheria carriers, gas gangrene, anthrax, tetanus, actinomycosis, syphilis, listeriosis.

2. Legionnaires' disease.

3. Mycoplasma pneumoniae pneumonia.

4. Pneumonia, garment proto-pneumonia.

5. Genitourinary infections caused by other genitourinary infections caused by chlamydia and mycoplasma.

6. Chlamydia trachomatis conjunctivitis.

7. Gonococcal infection.

8. Oral infections caused by anaerobic bacteria.

9. Campylobacter jejuni enteritis.

10. Pertussis.

Dosage

Intravenous infusion: children should be divided into 2~3 times according to their body weight 20~30mg/kg per day

Oral: Children should take 30~50mg/kg a day according to their body weight, divided into 3~4 times.

Medication precautions

1. Gastrointestinal reactions are common, including abdominal fouling, nausea, vomiting, middle and upper abdominal pain, mouth and tongue pain, and decreased gastric intake, and their incidence is related to the dose size.

2. Hemolytic streptococcal infection should last for at least 10 days to prevent the occurrence of acute rheumatic fever.

3. This product can enter the fetal circulation through the placenta, and pregnant women should still weigh the pros and cons when applying.

4. This product can inhibit the metabolism of carbamazepine and valproic acid, resulting in an increase in the blood concentration of the latter and toxic reactions. Combination with astemizole or terfenadine can increase cardiotoxicity, and combination with cyclosporine can increase blood concentrations of the latter and produce nephrotoxicity.

5. This product has an antagonistic effect with lincosamides, and it is not recommended to use it in combination.

6. This product is a bacteriostatic agent, which can interfere with the bactericidal effect of penicillin, so when rapid bactericidal effect is required, such as the treatment of meningitis, the two should not be combined.

Reference Sources:

[1] National Health Commission, State Administration of Traditional Chinese Medicine.Pertussis diagnosis and treatment protocol (2023 edition)[J].International Journal of Epidemiology and Infectious Diseases,2024,51(1):1-3.

[2] Wang Fu, Zhang Fuyuan.Practical Anti-infective Therapeutics (Third Edition)[M].People's Medical Publishing House.2020

[3] Yang Baofeng, Chen Jianguo.Pharmacology(9th Edition)[M].People's Medical Publishing House.2018

[4] He Lixian, Xiao Yonghong, Lu Quan, et al.National antimicrobial treatment guidelines[M].People's Medical Publishing House.2018

[5] Lin Jiangtao, Zhang Yongming, Wang Changzheng, et al. Expert consensus on the antimicrobial extramicrobial effect and clinical application of macrolides[J]Chinese Journal of Internal Medicine,2017,56(7):546-557.

[6] Hou Ning, Lin Dianjie.Handbook of clinical application of macrolide antimicrobial drugs[M].Peking Union Medical College Press,2015

[7] Guidelines for the clinical application of antimicrobial drugs[M].People's Medical Publishing House,2015

[8] Guiding opinions on the clinical application of macrolide antimicrobial drugs in adults and children in the emergency department[J].China Emergency Medicine,2020,40(11):1-36-1045.

[9] Expert consensus on the antimicrobial extramicrobial effect and clinical application of macrolides[J].Chinese Journal of Internal Medicine,2017,56(7):546-554.