EVIDENCE-BASED CHILD HEALTH: A COCHRANE REVIEW JOURNAL Evid.-Based Child Health 7: 957–958 (2012) Published online in Wiley Online Library (http://www.evidence-basedchildhealth.com). DOI: 10.1002/ebch.1846 Commentary Commentary on ‘Antibiotics for whooping cough (pertussis)’ This is a commentary of Cochrane review, published in this issue of EBCH, ﬁrst published as: Altunaiji SM, Kukuruzovic RH, Curtis NC, Massie J. Antibiotics for whooping cough (pertussis). Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004404. DOI: 10.1002/14651858.CD004404.pub3. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Commentary by Julie H. Shakib Pertussis is a common communicable disease with severe and sometimes fatal consequences in young infants (1–5). In this review, Altunaiji et al. assessed the risks and beneﬁts of antibiotic treatment and con- tact prophylaxis in both children and adults. The authors identiﬁed two main reasons for conducting this systematic review. First, with respect to treat- ment, they cited concerns regarding ease of adherence, compliance and optimal duration of standard antibiotic therapy, which they deﬁned as a 14-day course of ery- thromycin. Second, they noted controversy regarding the necessity and effectiveness of antibiotic prophy- laxis for contacts of an index case. The most recent US Centers for Disease Control and Prevention antimicrobial guidelines for treatment and post-exposure prophylaxis of pertussis were pub- lished in 2005 (6). These US Centers for Disease Control and Prevention guidelines broadened the cat- egory of primary agents recommended for pertussis treatment and prophylaxis by age group from a 14- day course of erythromycin to include either a ﬁve-day course of azithromycin (preferred in infants younger than one month due to the potential risk for infan- tile hypertrophic pyloric stenosis that has been asso- ciated with erythromycin) or a seven-day course of clarithromycin. The guidelines recommend a 14-day course of trimethoprim–sulfamethoxazole as an alter- native agent for patients with speciﬁc contraindications to macrolide therapy with the exception of infants younger than two months of age (6). The US Cen- ters for Disease Control and Prevention guidelines also reafﬁrm a risk-based approach to contact prophylaxis dependent on multiple factors. These factors include intensity of exposure, presumed infectiousness of the index case, and, importantly, whether the exposed individual is at high risk for morbidity or mortality such as an infant under one year or a woman in the third trimester of pregnancy. In their review, Altunaiji et al. systematically iden- tiﬁed randomized controlled trials comparing different antibiotic agents or the same antibiotic with differ- ent dosing regimens or duration of therapy to placebo or no treatment in children and adults with clinical or laboratory-conﬁrmed pertussis and their contacts. Stated objectives of the review were to determine the following for each antibiotic regimen with regard to treatment and contact prophylaxis: (1) success in achieving microbiologic eradication, (2) adequate dose and duration of therapy to achieve eradication, (3) improvement in, or in the case of prophylaxis, prevention of clinical symptoms and (4) side effect proﬁle. Primary outcomes included clinical measures, such as symptom frequency, duration and associated complications, mortality, remission status, number of contacts developing pertussis and microbiologic erad- ication and/or relapse. Secondary outcomes included adverse events and antibiotic-associated side effects, as well as patient compliance and tolerance of pre- scribed antibiotics. Using the Cochrane framework, the authors identiﬁed and reviewed 13 clinical trials that met inclusion criteria. The authors’ analysis of primary endpoints demon- strated that a wide variety of antibiotic regimens suc- cessfully eliminated Bordetella pertussis from culture- positive patients. Although ﬁve of the treatment tri- als showed efﬁcacy of chloramphenicol or oxyte- tracycline, the authors clearly and correctly advised against the use of these antibiotics due to poten- tial side effects and the availability of safer and equally effective antibiotics. Regimens found to be effective in eradication included three to ﬁve days of azithromycin, 7–14 days of erythromycin, seven days of clarithromycin or seven days of trimetho- prim–sulfamethoxazole. The same antibiotics identi- ﬁed by this review as effective for eradication were recommended by the 2005 US Centers for Disease Control and Prevention guidelines. The results of the review also demonstrated successful microbiologic clearance with fewer side effects for three to ﬁve days of azithromycin or seven days of clarithromycin. Pooled subgroup analysis of four trials demonstrated no signiﬁcant improvement in microbiologic clearance Copyright  2012 John Wiley & Sons, Ltd.