How Is Pertussis Treated? What Doctors Want You to Know
Got a cough that just won't go away? It could be pertussis, also known as whooping cough. Here's how to treat this stubborn cough.
What is pertussis?
Pertussis is a highly contagious respiratory illness known for a cough that simply won’t go away.
This stubborn cough can grow so severe that it triggers a gasping or whooping sound as a person tries to inhale—lending the disease its more common name, whooping cough.
“We also call it the hundred-day cough,” says Gina Posner, MD, a board-certified pediatrician at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “It just keeps going.”
According to the Centers for Disease Control and Prevention (CDC), about 15,000 to 20,000 cases are reported in the United States each year.
Dr. Posner explains that while anyone can catch whooping cough, adults don’t often have serious repercussions. It can be much more dangerous for children and babies.
That’s why experts say it’s important to know the illness’s signs and how to get pertussis treatment.
Early intervention helps to ease the course of the cough and lower the risk of complications while curbing its spread to more vulnerable individuals.
What causes pertussis?
Whooping cough is caused by bacteria called Bordetella pertussis.
When these airborne pathogens get into our airways, they stick to tiny hairs that line our lungs. This leads to inflammation and swelling, causing a dry, persistent cough.
Pertussis spreads very easily. While transmission rates are lower than in the pre-vaccine era, it can still spread to 20 percent of school and 50 percent of household contacts. Among nonimmunized households, that rate spikes to between 70 and 100 percent.
“We used to see more cases, with grandparents spreading it to an infant,” Dr. Posner says. “But because we have the TDaP [tetanus, diphtheria, and pertussis vaccine] we see a lot less of that now.”
Still, she says that one of the greatest risks of pertussis as an adult is spreading it to unvaccinated or under-vaccinated kids (they miss booster shots).
The risks of pertussis
About 50 percent of infants with pertussis require hospitalization due to complications like pneumonia, ear infections, dehydration, and seizures. However, the most common and dangerous complication for infants is apnea—the inability to breathe.
“The sad reality is the one out of 100 [infants] will die,” said Robin Squellati, a professor in the nursing department at Walden University. “Only a small percentage of older children or adults will get pneumonia or other, more serious complications.”
But she says that adults with underlying health conditions like cardiac disease, lung disease, or a weakened immune system are more at risk and may require hospitalization.
In general, otherwise healthy adults are more likely to experience adverse effects from the cough itself. These include physical traumas like broken ribs, injured back muscles, torn abdominal tissues, or broken blood vessels.
Symptoms usually develop within seven to 10 days after exposure to pertussis.
The seriousness of this condition varies depending on age, vaccination history, and other medical conditions an individual may have, says Benjamin Caplan, MD, a board-certified doctor of family medicine and founder and chief medical officer of the CED Foundation and CED Clinic in Chestnut Hill, Massachusetts.
- General tiredness
- Runny eyes and nose
- A mild cough
- Low-grade fever
The infection then evolves into pertussis’s trademark cough.
There’s not always a “whoop” sound on inhale—this effect is actually more common among children, not adults. But most people experience vigorous coughing that goes on for weeks before easing up.
This ongoing cough is responsible for pertussis’s other potential symptoms: vomiting, headaches, blue-colored lips, and exhaustion.
“Between all phases, the duration can be three to four months or even longer,” Dr. Caplan says.
Recognizing pertussis may be more complicated in younger cases.
“It often presents differently in adults and children,” Dr. Posner explains. “Sometimes the only symptom in a one-month-old is that they turn blue and stop breathing.”
The illness comes with a tricky paradox that can make its diagnosis difficult.
Because early symptoms are often mild and cold-like, they’re easy to overlook or ignore—but this period is when treatment is most effective.
That’s why experts say it’s important to inform your doctor if you have:
- Cold or allergy-like symptoms that won’t go away
- Gaps in your pertussis vaccination history
- Possible pertussis exposure
If you suspect you have whooping cough, your doctor can confirm the diagnosis with a blood test or a nose and throat culture.
“Pertussis treatment can still take a few weeks,” Dr. Posner said. “But it tends to not turn into the horrendous cough.”
The go-to whooping cough treatment is a round of antibiotics, like azithromycin or clarithromycin.
“Courses can range from five to 14 days and, in some cases, up to six weeks,” says Dr. Caplan.
But there’s a catch.
“Antibiotics will not work after [you’ve had pertussis for] about three weeks, due to the body already combating the bacteria,” according to Squellati.
She says that the earlier a patient starts antibiotics within this window, the less damage the cough can cause to the respiratory tract.
It’s this physical damage that can make symptoms last for months even after the illness resolves. Greater damage also increases the risk of complications like pneumonia.
This is also why it’s normal for a cough to continue after completing medication.
Dr. Caplan says that while antibiotics typically eliminate the infection effectively, recovery—and the coughing—can last as long as it takes our tissues to heal.
How to stop the spread
Antibiotics also play an important role in preventing the spread of this highly contagious disease.
Squellati says that patients are no longer contagious after five days on antibiotics, whereas untreated cases are infectious for about three weeks.
People at risk for contracting pertussis—like those living in the same household as an infected individual—may also receive antibiotics as a preventive measure.
At-home whooping cough treatment
Experts suggest that—in combination with medical therapy—patients can soothe their cough with:
- A cool mist vaporizer to help loosen mucus
- Dark honey or other natural cough remedies
- Conscious hydration, even if you don’t feel thirsty
- Frequent, small, nutritious meals
- Plenty of rest in an upright position (lying down flat may aggravate the cough)
“Over-the-counter cough medicines are discouraged,” says Squelatti. They are not typically effective in controlling whooping cough and can bring unwelcome side effects, especially for infants and small children.
Recognizing and avoiding what triggers a cough can also help people manage pertussis symptoms.
These triggers can include exercise, yelling, yawning, or stretching, as well as irritants like dust, smoke, and fumes.
“The more fragile, frail, and medically complicated an individual is, the more likely they may have serious or even life-threatening manifestations of a pertussis infection,” says Dr. Caplan.
This is especially true for young infants who have not received a pertussis vaccination and children who are not fully immunized.
Parents should immediately seek medical care if their child has trouble breathing, turns blue, or shows signs of dehydration.
Older kids and adults may require hospitalization in severe cases to ensure they’re getting enough oxygen and fluids as they recover.
Mild sedation is also sometimes used to ease heavy or painful coughing.
As for the best pertussis treatment? Experts agree that it’s prevention through vaccination—and avoidance of people with the disease.
There are two vaccines available for pertussis. DTaP is given to children to develop immunity against pertussis, diphtheria, and tetanus.
Children receive their first DTaP at two months of age. Then there are two subsequent vaccinations given at four months and six months—and boosters administered at ages 15 to 18 months and between four and six years old.
Squelatti says it takes this full four- to six-year period for the dosage to reach 80 to 90 percent effectiveness. “This is why infants and young children are so vulnerable.”
She says that research is ongoing to develop a vaccine for infants who are less than two months old. But the booster vaccination—TDaP—is encouraged for pregnant women, as it does provide infants some protection at birth. (Learn more about the Tdap vaccine in pregnancy.)
“Over time, the [DTaP] vaccine becomes less effective, which is why adults should have another TDaP every 10 years,” she explains.
Yet according to the CDC, less than 28 percent of U.S. adults age 19 to 64 get re-immunized.
Keep an eye on that cough
To keep yourself and your loved ones safe from pertussis, make sure to check with your doctor to see if you’re up to date on your vaccination.
You should also schedule an appointment to get tested if you think you’ve been exposed or have a stubborn cough. Early whooping cough treatment leads to the best outcomes.
Due to the illness’s infectious nature, there may also be additional resources available in your community.
“If people are without insurance, they should call their local public health department for advice on diagnosis and treatment methods,” says Squelatti.
- Gina Posner, MD, board-certified pediatrician at MemorialCare Orange Coast Medical Center in Fountain Valley, California
- Benjamin Caplan, MD, board-certified doctor of family medicine and founder and chief medical officer of CED Foundation and CED Clinic
- Robin Squellati, PhD, APRN-C, faculty member for Walden University's Master of Science in Nursing Program
- Centers for Disease Control and Prevention: "Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2016"
- Centers for Disease Control and Prevention: "2021 Recommended Vaccinations for Infants and Children (birth through 6 years) Parent-Friendly Version"
- Centers for Disease Control and Prevention: "Pertussis Cases by Year (1922 – 2018)"
- Centers for Disease Control and Prevention: "Pertussis (Whooping Cough) Causes and Transmission"
- Centers for Disease Control and Prevention: "Pertussis (Whooping Cough) Clinical Complications"
- Centers for Disease Control and Prevention: "Pertussis (Whooping Cough) Postexposure Antimicrobial Prophylaxis"
- New York State Department of Health: "Pertussis or Whooping Cough Fact Sheet"
- Shehab, Ziad M., Pediatric Respiratory Medicine (Second Edition,) Mosby, 2008: "Pertussis"