In accordance, there is some evidence from earlier studies, that clinical features, such as age, presence of cough Selleckchem Depsipeptide and absence of dyspnea,
may be useful to separate B. pertussis from viruses in young children with respiratory infection. Among 141 North-American infants hospitalized for suspected pertussis, PCR was positive for B. pertussis in 15%, and in retrospective analyses, the positive infants were younger and presented with lower respiratory rate and higher blood lymphocyte counts. 11 Among 126 English children aged less than 5 months treated in the pediatric intensive care unit for respiratory infection, PCR or serology was positive for B. pertussis in 20%, and in retrospective analyses, the B. pertussis-positive infants presented with longer duration of cough, more apneas, more coughing spells, and higher blood lymphocyte counts. 12 Mixed RSV-pertussis infection was present in 36% of B. pertussis-positive cases. In all, 126 French children aged less than 4 months were
recruited in a prospective study, and PCR was positive for B. pertussis in 16%, and the positive and negative infants differed significantly only for the presence of coughing spells. 13 Mixed pertussis-RSV infection was identified in 12%. Ferronato et al. concluded that the etiological diagnosis of viral Crenolanib manufacturer infection by PCR may enable the reduction of the use of antibiotics, especially that of macrolides, for suspected but non-proved pertussis cases. 10 Of course this is true, but the benefits
are marginal. In addition, the identification of RSV or other respiratory viruses does not rule B. pertussis infection out, since mixed infections are common. 8 and 9 Moreover, PCR is so sensitive that false-positive findings are possible, reflecting for example previous infection or clinically insignificant temporary carriage. When pertussis in young children is considered, under-treatment may be a more severe problem than over-treatment, since pertussis may be severe, even fatal in non-vaccinated or partially vaccinated infants. 14 The bulk of the misuse of antibiotics comes from the treatment of common colds and other mild upper respiratory infections with antibiotics, Selleck RG7420 including overtreatment of suspected acute otitis media with broad-spectrum antibiotics. A recent Cochrane review, updated in 2011, included 13 clinical studies on the role of antibiotics in whooping cough, and the authors concluded that azithromycin and clarithromycin are equally effective as erythromycin in the eradication of B. pertussis from the airways of children. 15 Clinical experience suggests that macrolides relieve the symptoms of whooping cough in infants but not in older children. However, the research evidence for the effect of antibiotic therapy is mainly lacking or is negative even in infants.