Tozzi Alberto Eugenio, Croci Ileana, Gesualdo Francesco, Perno Carlo Federico, Linardos Giulia, Villani Alberto, Russo Luisa, Campagna Ilaria, Ferro Diana, Pandolfi Elisabetta
Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, 00165 Rome, Italy.
Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children's Hospital, IRCSS, 00165 Rome, Italy.
Antibiotics (Basel). 2025 Mar 8;14(3):279. doi: 10.3390/antibiotics14030279.
A resurgence of pertussis has been observed in several geographic areas in the post-COVID-19 era. Macrolides are the first-choice antibiotics for the treatment of pertussis. Limited data exist on the impact of the early administration of clarithromycin or azithromycin on infants' pertussis symptoms. This retrospective cohort study analyzed infants enrolled in an enhanced surveillance program for pertussis at a single Italian clinical reference center between 2015 and 2020. All cases were laboratory-confirmed. This study compared outcomes based on the timing of macrolide antibiotic treatment: early administration (within 7 days of cough onset) versus late administration (8 days or later). Key outcomes included cough duration, symptom frequency, and complication rates. : We studied 148 infants with confirmed pertussis. The median duration of coughing was 14 days in infants with early administration and 24 days in those with late administration. The occurrence of symptoms differed for apnea (62.6% for early administration; 84.6% for late administration). In a multivariable Cox model, the duration of the cough was lower in infants receiving antibiotics within 7 days from the beginning of the cough compared with those starting later (HR = 0.36, 95% CI: 0.25-0.53, < 0.001). Clarithromycin was associated with a shorter duration of coughing (HR = 0.42, 95% CI: 0.19-0.92, = 0.030) independently from other factors. Regarding the occurrence of symptoms, children receiving antibiotics later were three times more likely to experience apnea compared to those treated early ( = 0.008). Early treatment with clarithromycin or azithromycin for infants with pertussis improves clinical symptoms. Clarithromycin may be more effective than azithromycin in shortening coughing. The early administration of antibiotics may also help prevent the spread of disease during the resurgence of pertussis and should be considered regardless of the laboratory confirmation, while taking into account the potential side effects of an unnecessary therapy.
在新冠疫情后时代，多个地理区域都出现了百日咳疫情反弹的情况。大环内酯类药物是治疗百日咳的首选抗生素。关于早期使用克拉霉素或阿奇霉素对婴儿百日咳症状的影响，现有数据有限。这项回顾性队列研究分析了2015年至2020年期间在意大利一家临床参考中心参加百日咳强化监测项目的婴儿。所有病例均经实验室确诊。本研究根据大环内酯类抗生素治疗的时间比较了治疗结果：早期给药（咳嗽发作7天内）与晚期给药（8天或更晚）。主要结果包括咳嗽持续时间、症状频率和并发症发生率。我们研究了148例确诊百日咳的婴儿。早期给药的婴儿咳嗽中位持续时间为14天，晚期给药的婴儿为24天。呼吸暂停症状的发生率有所不同（早期给药为62.6%；晚期给药为84.6%）。在多变量Cox模型中，与开始咳嗽后较晚开始使用抗生素的婴儿相比，在咳嗽开始7天内接受抗生素治疗的婴儿咳嗽持续时间更短（风险比=0.36，95%置信区间：0.25-0.53，P<0.001）。独立于其他因素，克拉霉素与较短的咳嗽持续时间相关（风险比=0.42，95%置信区间：0.19-0.92，P=0.030）。关于症状的发生，与早期接受治疗的儿童相比，晚期接受抗生素治疗的儿童发生呼吸暂停的可能性高出三倍（P=0.008）。对患有百日咳的婴儿早期使用克拉霉素或阿奇霉素可改善临床症状。克拉霉素在缩短咳嗽方面可能比阿奇霉素更有效。在百日咳疫情反弹期间，早期使用抗生素还可能有助于预防疾病传播，无论实验室是否确诊，都应予以考虑，同时要考虑不必要治疗的潜在副作用。
