Treatment of Acute Pertussis Infection

Whether vaccine breakthrough or unvaccinated, priority for whooping cough is on early therapeutics

By Peter A. McCullough, MD, MPH

A Dallas newspaper suggested that a few reported pertussis cases may deter family gatherings for Thanksgiving. The Dallas Morning News published this statement on November 28, 2025:

Pertussis, also known as whooping cough, is on the rise with outbreaks across the country, leaving some parents of infants wondering whether they should travel or visit family at all.

As an adult doctor I have never tested for the infection but undoubtedly I treated pharyngitis and cough due to Bordetella pertussis with empiric antibiotic and nebulizer therapy. Alter AI assisted in this review.

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🧠 Treatment of Pertussis in Children When Vaccination Fails

Pertussis, or whooping cough, is a highly communicable respiratory infection caused by Bordetella pertussis. Despite decades of widespread vaccination, pertussis continues to resurge worldwide—particularly among populations with full vaccination coverage. The failure of acellular vaccines (DTaP and Tdap) to confer lasting immunity has refocused attention on effective treatment strategies for children who still contract the disease. Treatment is primarily aimed at shortening the infectious period, managing symptoms, and preventing complications, particularly in infants.

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⚕️ The Challenge of Vaccine Failure

While acellular pertussis vaccines were introduced to minimize adverse effects associated with the older whole-cell version, this shift has had long-term consequences. As multiple sources—including the World Journal of Pediatrics (Hua, 2024) and The Journal of Immunology (2020)—highlight, immunity conferred by current vaccines wanes rapidly, often within 4–6 years after the final childhood dose. The acellular vaccine’s limited antigenic profile has also been linked to immune escape and genetic mutations in circulating B. pertussis strains, leading to reduced coverage against modern variants.

Therefore, the persistence of pertussis despite high vaccination rates is not merely a matter of “vaccine hesitancy,” as often portrayed, but rather an outcome of biological and policy miscalculations. The recognition of this vaccine shortcoming underscores the necessity for robust clinical management when immunized children still contract the disease.

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💊 Medical Management

1. Early Antibiotic Therapy

Mainstream guidelines, including those by the Centers for Disease Control and Prevention (CDC, 2024) and Medscape (2025), recommend initiating antibiotic treatment as early as possible, ideally within the first two weeks of infection when bacterial replication is at its peak. Early intervention reduces transmission risk but has limited effect on symptom severity once the paroxysmal cough phase is established.

The preferred antibiotic for most pediatric cases is azithromycin, administered as follows:

• Infants <6 months: 10 mg/kg/day orally or IV for 5 days.

• Children >6 months: 10 mg/kg (max 500 mg) on day 1, followed by 5 mg/kg (max 250 mg) on days 2–5. [UCSF, 2025]

When macrolide resistance or hypersensitivity occurs—an emerging concern especially in Asia and Eastern Europe—trimethoprim–sulfamethoxazole (TMP-SMX) can serve as an alternative for children over 2 months. Recent Chinese expert consensus has also identified intravenous piperacillin or cefoperazone–sulbactam as viable alternatives in severe or erythromycin-resistant cases (Hua, 2024).

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2. Supportive and Critical Care

Pharmacologic therapy alone is insufficient in severe pediatric cases—especially in infants less than six months, who face high mortality from apnea, pneumonia, and hypoxia.

Supportive treatment strategies include:

• Oxygen therapy or mechanical ventilation in cases of respiratory distress, cyanosis, or severe hypoxia.

• Nutritional and hydration support through nasogastric feeding or IV fluids when coughing fits impede oral intake.

• Monitoring for apnea, bradycardia, and seizures, especially in ICU settings.

Medscape (2025) and UpToDate (2025) note that hospitalization is required for all infants under three months with moderate or severe paroxysms, failure to thrive, or neurologic complications. Additional vigilance is warranted when B. pertussis infection co-occurs with respiratory syncytial virus (RSV) or other pathogens, as coinfections significantly heighten morbidity (Snodgrass, 2025).

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🧬 Resistance and Evolving Pathogens

An emerging problem since 2010 is the rise of erythromycin-resistant B. pertussis (ERBP). In China, resistant strains account for 50–100% of isolates, with minimum inhibitory concentrations exceeding 256 mg/L (Hua, 2024). This poses a major challenge since international treatment guidelines still largely assume universal macrolide sensitivity. Overreliance on azithromycin may accelerate this resistance trend.

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🌿 Holistic and Alternative Considerations

Given the adverse side effects of antibiotics and vaccine limitations, supportive integrative care deserves renewed focus. Adequate vitamin A, C, and D levels are critical for immune resilience, particularly in children recovering from respiratory infections. Nebulized saline or herbal expectorants (such as ivy leaf extract or glycyrrhizin from licorice) have also demonstrated mild clinical benefit in easing cough paroxysms and promoting mucus clearance in pediatric respiratory illnesses, though rigorous independent research is still insufficient.

Furthermore, chronic exposure to indoor pollutants or chemical irritants may aggravate pertussis severity, underscoring the importance of environmental detoxification as part of recovery and secondary prevention.

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🩺 Post-Exposure and Reinfection Prevention

Antibiotic prophylaxis should target household contacts and caregivers of infected children, particularly those at risk for severe disease (newborns, pregnant women). Azithromycin remains the first-line agent for prophylaxis available in the adult Medical Emergency Kit from The Wellness Company.

A growing body of literature, such as PNAS (Bjørnstad, 2011), underscores the concept of natural immune boosting—repeated low-level exposure to circulating organisms that historically helped sustain population immunity.

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🔍 Conclusion

Treating pertussis in vaccinated children requires a realistic understanding of evolving pathogen resistance, waning vaccine protection, and the need for comprehensive supportive care. While current antibiotic protocols remain the cornerstone of therapy, growing macrolide resistance and incomplete vaccine-induced immunity demand innovative therapeutic and preventive frameworks—balancing pharmaceutical precision with holistic immune support and genuine transparency in data reporting. The ultimate solution will not come from additional boosters alone but from re‑examining how we foster robust, lifelong immunity in the next generation.

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Peter A. McCullough, MD, MPH

Chief Scientific Officer, The Wellness Company

www.twc.health

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📚 References

1. Centers for Disease Control and Prevention (CDC). Treatment of Pertussis. November 6, 2024.

2. Medscape Reference. Pertussis Treatment & Management. February 5, 2025.

3. Hua, C.Z. Expert Consensus for Pertussis in Children: New Concepts in Diagnosis and Treatment. World J. Pediatr., 2024.

4. UpToDate. Pertussis Infection in Infants and Children: Treatment and Prevention. May 2025.

5. Snodgrass, A. M. et al. Pertussis in Children in an Era of Vaccination. Pediatric Respirology and Critical Medicine, 2025.

6. Bjørnstad, O. N. Natural Immune Boosting in Pertussis Dynamics. PNAS, 2011.

7. Sokou, R. et al. Pertussis in Early Infancy: Diagnostic Challenges and Disease Burden. Vaccines (MDPI), 2025.

8. UCSF IDMP. Pertussis Antimicrobial Therapy Guidelines. 2021.

9. NIAID Workshop Report. Overcoming Waning Immunity in Pertussis Vaccines. J. Immunology, 2020.

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