Dawaa Reference

infectious

Pertussis (Whooping Cough)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

CDC Pertussis Postexposure Prophylaxis and Treatment 2019 · CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html) · Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph)

Verified against5 documents
  • CDC Pertussis Postexposure Prophylaxis and Treatment 2019
  • CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph)
  • Pertussis - disease-level clinical article (pertussis-clinical.txt)
  • MSF Essential Drugs 2024

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Paroxysmal coughing fits, an inspiratory whoop, and vomiting after coughing are classic but not individually reliable [cough · vomiting]
  • A cough of any length with a known case contact, or a cough lasting at least 2 weeks with paroxysms, whoop, vomiting, or apnea, meets the case definition [apnoea · cough · vomiting]
  • Adults and teens often have just a prolonged cough over 2 weeks with no whoop or vomiting, which can delay diagnosis [cough]
  • Fever present, or no paroxysmal coughing at all, makes pertussis unlikely in an adult [fever]

Signs — what you find (1)

  • In infants under 1 year old, apnea itself can be the presenting sign rather than a typical cough [apnoea]

Tests (5)

  • PCR testing is 77% to 97% sensitive and 88% to 97% specific when done within 1 to 4 weeks of symptom onset
  • Culture is 100% specific and remains the gold standard, but takes 7 to 10 days to grow
  • Serology is most useful 3 to 12 weeks after symptom onset but is unreliable in infants under 6 months or the recently vaccinated
  • A white count over 20,000 per microliter with more than half lymphocytes in an infant under 3 months strongly suggests pertussis
  • Fluorescent-antibody staining of secretions is now considered outdated and unreliable for diagnosis

If not this — what else fits (5)

  • A milder illness that needs PCR or culture to tell apart from true pertussis points to B. parapertussis
  • Fever, lung crackles, and higher CRP with a shorter cough course in a school-age child favor Mycoplasma over pertussis
  • A short 1 to 3 day incubation with fever and a non-paroxysmal cough points to a viral cause instead
  • Wheeze that responds to a bronchodilator, without whooping paroxysms, favors asthma over pertussis
  • A sudden-onset cough with a choking history and one-sided wheeze suggests foreign body aspiration rather than pertussis

SourceStatPearls "Pertussis" - disease-level clinical article

Presentation findings are traced to the source above.

1

AZITHROMYCIN

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg single dose on Day 1, then 250 mg once daily on Days 2-5 x 5 days

Paediatric dose

(Two different regimens - check the age first. Under 6 months: 10 mg/kg once daily for 5 days, the same dose every day. 6 months and over: 10 mg/kg (max 500 mg) on day 1, then 5 mg/kg (max 250 mg) once daily on days 2-5. It is not a step-down under 6 months, and halving day 2 in a young infant under-treats the group most likely to die of this.)

Dose by age
Under 6 months:10 mg/kg once daily for 5 days - the same dose every day, not a step-down
6 months and over:10 mg/kg (maximum 500 mg) on day 1, then 5 mg/kg (maximum 250 mg) once daily on days 2 to 5
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

CDC Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, MMWR Recomm Rep 2005;54(RR-14):1-16, treatment table by age band - reprinted in full at Am Fam Physician 2006;74(2):333-336 (aafp.org/pubs/afp/issues/2006/0715/p333.html)

Why

First-line macrolide therapy; preferred over erythromycin due to shorter duration and better compliance

Cautions
  • Azithromycin is the macrolide of choice under 1 month. Erythromycin is associated with infantile hypertrophic pyloric stenosis and clarithromycin is not recommended in this age group - but the risk of untreated pertussis in a neonate outweighs the risk of IHPS.
  • Early treatment (catarrhal phase) reduces disease severity; treatment in paroxysmal phase mainly prevents transmission.
  • Monitor infants <6 weeks for infantile hypertrophic pyloric stenosis with macrolides.
  • POST-EXPOSURE PROPHYLAXIS, article verbatim: "PEP is recommended for household and close contacts, particularly those at high risk (infants, pregnant women, and immunocompromised individuals) and for healthcare personnel exposed to high-risk patients."
  • The prophylactic regimen is this same regimen, and there is a deadline: "PEP is most effective when initiated within 21 days of cough onset in the index case. The same macrolide regimens used for treatment (typically azithromycin) are recommended for prophylaxis."
  • Being vaccinated does not exempt a contact: "Regimens mirror treatment antibiotics (commonly azithromycin), and prior vaccination does not obviate the need for PEP."
Egyptian brands
Egyptian brandManufacturerIndicative price
AZATRIBACT 500MG 3 CAPS.RIVA PHARMA S.A.E.13.50 EGP (4.50/unit)
GIGAZOCIN 500MG 5 CAPS.EGPI > PIONEER27.50 EGP (5.50/unit)
SYSTYMYCIN 500MG 3 CAPS.EGPI > NOVELL PHARMA21.50 EGP (7.17/unit)
AZITHROMASH 500 MG 3 F.C. TABS.MASH PREMIERE48.00 EGP (16.00/unit)
AZALIDE 500MG 3 CAPS.UP PHARMA52.00 EGP (17.33/unit)
AZROLID 500 MG 6 F.C.TABS.AMRIYA126.00 EGP (21.00/unit)
ZERAMERATE 500 MGEGPI > GAMMA PHARMA28.50 EGP
DISTABCIN 500 MG 3 DISPERSIBLE TABS.EGPI43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solidEL-OBOUR > AVERROES PHARMA-EGYPT12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solidORGANO PHARMA > NOVELL PHARMA12.75 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Pertussis - disease-level clinical article (pertussis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Infants younger than 6 months may need hospitalization, given the risk of apnea, hypoxia, dehydration, and pneumonia.
3

CLARITHROMYCIN

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice daily x 7 days

Paediatric dose

7.5 mg/kg/dose [child max 500 mg]

(7.5 mg/kg twice daily for 7 days)

Dose by weight
3kg22.5 mg/dose
4kg30 mg/dose
5kg37.5 mg/dose
6kg45 mg/dose
7kg52.5 mg/dose
8kg60 mg/dose
9kg67.5 mg/dose
10kg75 mg/dose
11kg82.5 mg/dose
12kg90 mg/dose
13kg97.5 mg/dose
14kg105 mg/dose
15kg112.5 mg/dose
16kg120 mg/dose
17kg127.5 mg/dose
18kg135 mg/dose
19kg142.5 mg/dose
20kg150 mg/dose
21kg157.5 mg/dose
22kg165 mg/dose
23kg172.5 mg/dose
24kg180 mg/dose
25kg187.5 mg/dose
26kg195 mg/dose
27kg202.5 mg/dose
28kg210 mg/dose
29kg217.5 mg/dose
30kg225 mg/dose
31kg232.5 mg/dose
32kg240 mg/dose
33kg247.5 mg/dose
34kg255 mg/dose
35kg262.5 mg/dose
36kg270 mg/dose
37kg277.5 mg/dose
38kg285 mg/dose
39kg292.5 mg/dose
40kg300 mg/dose
41kg307.5 mg/dose
42kg315 mg/dose
43kg322.5 mg/dose
44kg330 mg/dose
45kg337.5 mg/dose
46kg345 mg/dose
47kg352.5 mg/dose
48kg360 mg/dose
49kg367.5 mg/dose
50kg375 mg/dose
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Choice

Clarithromycin is the first choice here; co-trimoxazole is a further option.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph)

Why

Clarithromycin is a macrolide antibiotic that reduces Bordetella pertussis carriage and transmission; it serves as an alternative macrolide to azithromycin, which remains preferred in very young infants.

Cautions
  • Not recommended under 1 month - use azithromycin.
  • Caution in renal impairment and QT prolongation risk.
  • Clarithromycin is an alternative macrolide option.
  • GI side effects (nausea, abdominal pain) are common.
Egyptian brands
Egyptian brandManufacturerIndicative price
KAPIFECTIN 500 MG 14 F.C.TAB.EVA PHARMA37.00 EGP (2.64/unit)
LARITHROCIN 500MG 14 F.C. TABS.GLOBAL NAPI PHARMACEUTICALS40.00 EGP (2.86/unit)
CAPRIVEXIN 500MG S.R. 14 F.C. TAB.HORUS FOR PHARMACEUTICAL PRODUCTS58.00 EGP (4.14/unit)
CLARINOTION XL 500 MG 14 F.C.TABS.RAMEDA > NOTION PHARMA83.00 EGP (5.93/unit)
KLARIMIX 500 MG 14 TAB.SIGMA > OCTOBER PHARMA144.00 EGP (10.29/unit)
INFECTOCURE 500 MG 14 F.C.TABS.EGPI156.00 EGP (11.14/unit)
KLACID 500 MG 14 F.C.TABS.KAHIRA > ABBOTT LABORATORIES257.00 EGP (18.36/unit)
KLACID XL 500 MG 14 F.C.TABS.KAHIRA > ABBOTT LABORATORIES299.00 EGP (21.36/unit)
KLARIMIX 125MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA36.00 EGP
KLARIMIX 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA52.00 EGP
4

CO-TRIMOXAZOLE

2nd line

Formoral.solid

Adult dose and duration

800 mg SMX/160 mg TMP twice daily x 14 days

Paediatric dose

4 mg/kg/dose [child max 160 mg]

(Child 6 weeks and over: 20 mg SMX/4 mg TMP/kg (max 800 mg SMX/160 mg TMP) twice daily for 14 days)

Dose by weight
3kg12 mg/dose
4kg16 mg/dose
5kg20 mg/dose
6kg24 mg/dose
7kg28 mg/dose
8kg32 mg/dose
9kg36 mg/dose
10kg40 mg/dose
11kg44 mg/dose
12kg48 mg/dose
13kg52 mg/dose
14kg56 mg/dose
15kg60 mg/dose
16kg64 mg/dose
17kg68 mg/dose
18kg72 mg/dose
19kg76 mg/dose
20kg80 mg/dose
21kg84 mg/dose
22kg88 mg/dose
23kg92 mg/dose
24kg96 mg/dose
25kg100 mg/dose
26kg104 mg/dose
27kg108 mg/dose
28kg112 mg/dose
29kg116 mg/dose
30kg120 mg/dose
31kg124 mg/dose
32kg128 mg/dose
33kg132 mg/dose
34kg136 mg/dose
35kg140 mg/dose
36kg144 mg/dose
37kg148 mg/dose
38kg152 mg/dose
39kg156 mg/dose
40kg160 mg/dose
41kg160 mg/dose (capped)
42kg160 mg/dose (capped)
43kg160 mg/dose (capped)
44kg160 mg/dose (capped)
45kg160 mg/dose (capped)
46kg160 mg/dose (capped)
47kg160 mg/dose (capped)
48kg160 mg/dose (capped)
49kg160 mg/dose (capped)
50kg160 mg/dose (capped)
Dose source

MSF Essential Drugs 2024

Why

Second-line antibiotic alternative for pertussis in patients who cannot tolerate macrolides.

Cautions
  • Contraindicated in infants under 6 weeks due to risk of hyperbilirubinemia.
  • Contraindicated in severe renal or hepatic impairment or known hypersensitivity to sulfonamides. MSF Essential Drugs 2024, CO-TRIMOXAZOLE = SULFAMETHOXAZOLE (SMX)/TRIMETHOPRIM (TMP) oral monograph (pages 103-105), Contra-indications: do not give it where renal or hepatic impairment is severe, or where there is a history of hypersensitivity to a sulfonamide.
Egyptian brands
Egyptian brandManufacturerIndicative price
CO-TRIMOXAZOLE 20 TABS.MUP5.00 EGP (0.25/unit)
COTRIL 400/80MG 20 TAB.EL NASR38.00 EGP (1.90/unit)
SEPTAZOLE FORTE 800/160MG 20 TABS.ALEXANDRIA56.00 EGP (2.80/unit)
SEPTRIN D.S 10 TABS.GLAXO SMITHKLINE > ASPEN PHARMA TRADING LIMITED28.00 EGP (2.80/unit)
SEPTAZOLE 400/80MG 20*10 TABS.ALEXANDRIA340.00 EGP (34.00/unit)
SUTRIM 400/80MG 20*10 TAB.MEMPHIS340.00 EGP (34.00/unit)
CO-TRIMOXAZOLE 200/40MG SUSP. 120ML? strength differs? different route - not oral solidMUP6.00 EGP
SUTRIM 200/40MG SUSP. 100ML? strength differs? different route - not oral solidMEMPHIS18.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.