Australian Regenerative Medicine Institute

Postinfectious Cough: Summary of Recommendations

Postinfectious Cough: Summary of RecommendationsCentral acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail.
Level of evidence, expert opinion; net benefit, intermediate; grade of evidence, E/B
When a patient has a cough lasting for > 2 weeks without another apparent cause and it is accompanied by paroxysms of coughing, posttussive vomiting, and/or an inspiratory whooping sound, the diagnosis of a B pertussis infection should be made unless another diagnosis is proven. Level of evidence, low; net benefit, substantial; grade of evidence, B
For all patients who are suspected of having whooping cough, to make a definitive diagnosis order a nasopharyngeal aspirate or polymer (Dacron; INVISTA; Wichita, KS) swab of the nasopharynx for culture to confirm the presence of B pertussis. Isolation of the bacteria is the only certain way to make the diagnosis. canadian neighbor pharmacy

Level of evidence, low; net benefit, substantial; grade of evidence, B
PCR confirmation is available but is not recommended as there is no universally accepted, validated technique for routine clinical testing. Level of evidence, low; net benefit, conflicting; grade of evidence, I
In patients with suspected pertussis infection, to make a presumptive diagnosis of this infection, order paired acute and convalescent sera in a reference laboratory. A fourfold increase in IgG or IgA antibodies to PT or FHA is consistent with the presence of a recent B pertussis infection. Level of evidence, low; net benefit, intermediate; grade of evidence, C
A confirmed diagnosis of pertussis infection should be made when a patient with cough has B pertussis isolated from a nasopharyngeal culture or has a compatible clinical picture with an epidemiologic linkage to a confirmed case. Level of evidence, low; net benefit, substantial; grade of evidence, B
Children and adult patients with confirmed or probable whooping cough should receive a macrolide antibiotic and should be isolated for 5 days from the start of treatment because early treatment within the first few weeks will diminish the coughing paroxysms and prevent spread of the disease; treatment beyond this period may be offered but it is unlikely the patient will respond.
Level of evidence, good; net benefit, substantial; grade of evidence, A
Long-acting P-agonists, antihistamines, corticosteroids, and pertussis Ig should not be offered to patients with whooping cough because there is no evidence that they benefit these patients. Level of evidence, good; net benefit, none; grade of evidence, D
All children should receive prevention against pertussis infection as part of a complete diphtheria, tetanus, acellular pertussis (DTap) primary vaccination series. This should be followed by a single dose DTap booster vaccination early in adolescence. Level of evidence, good; net benefit, substantial; grade of evidence, A
For all adults up to the age of 65, vaccination with the stronger formulation of TDap vaccine should be administered according to CDC guidelines. Level of evidence, expert opinion; net benefit, substantial; grade of evidence, E/A

Category: Respiratory Symptoms

Tags: Bordetella pertussis, pertussis infection, postinfectious cough, postviral cough