Synopsis
Recognise age-dependent pertussis, protect young infants from apnoea and deterioration, select testing by cough duration, give timely eradication treatment, notify and manage exclusion and contacts with UKHSA, and use vaccination to prevent severe disease.
- Pertussis begins with a catarrhal phase resembling a cold, then develops paroxysms of repeated cough, inspiratory whoop, post-tussive vomiting and exhaustion; cough commonly lasts 6–8 weeks or longer.
- Infants may present with apnoea, cyanosis, poor feeding or bradycardia and no whoop. Adolescents and vaccinated children may have prolonged nonspecific cough.
- Suspect pertussis with cough lasting 2 weeks or more plus paroxysms, whoop or post-tussive vomiting, or earlier when epidemiology or infant apnoea is compatible.
Key red flags
Any apnoea, cyanosis, bradycardia, seizure, reduced consciousness or exhaustion in an infant requires urgent hospital assessment.
Investigation priorities
Confirm infection using the current UKHSA algorithm without delaying notification.
Management branches
A compatible cough or infant apnoea syndrome is identified.
- Assess age-specific severity and admit young or physiologically compromised infants.
- Notify on clinical suspicion and collect the test recommended for age and cough duration.
Key medicines
ClarithromycinNeonate and child under 8 kg: 7.5 mg/kg orally twice daily for 7 days. At 8 kg and above use the current UKHSA weight bands; age 12–17 years: 500 mg twice daily for 7 days.
AzithromycinNeonate and infant: 10 mg/kg orally once daily for 3 days; after 6 months use 10 mg/kg once daily, maximum 500 mg, for 3 days.