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Internist infectious disease

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Treatment of pertussis

Alexey Portnov, medical expert
Last reviewed: 19.11.2021

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Hospitalization is required for young children, as well as for all patients who have pertussis in severe form and with complications. Treatment of whooping cough is mainly pathogenetic and symptomatic.

Treatment of pertussis light and moderate in severity

Antibiotics are effective only at the very beginning of the disease (in the catarrhal period) and in the early days of a spasmodic cough. Early use of antibiotics contributes to a significant relief of coughing attacks, reducing their number and reducing the duration of the disease. Recommended levomitsetin, erythromycin, ampicillin in age doses. The course of treatment is 7-10 days. In the spasmodic period, antibiotics are ineffective.
To reduce the frequency and severity of attacks of spasmodic cough, neuroleptic drugs (aminazine, propazine) are prescribed that relieve bronchospasm, reduce the excitability of the respiratory center, help calm the patient and deepen sleep (2.5% solution of aminazine is administered parenterally at a rate of 1-3 mg / kg in day with the addition of 3-5 ml of 0.25% solution of novocaine).
To combat hypoxia and hypoxemia, oxygen therapy is prescribed, preferably in an oxygen tent. During apnea, it is necessary to suck off mucus from the nose and oropharynx and perform artificial ventilation of the lungs.
To suppress the allergic component widely used antihistamines: dimedrol, promethazine, chloropyramine (suprastin), etc. In normal doses. In severe cases with a good effect, glucocorticoids are used based on prednisolone 1.5-2 mg / kg per day for 7-10 days.
Widespread use of drugs that dilute viscous sputum and improve the function of external respiration. Inhalation of aerosols of ambroxol with proteolytic enzymes (trypsin, chymotrypsin) and antispasmodics (euphyllin, ephedrine) is used.

Throughout the disease, the patient is shown fresh cool air, which soothingly acts on the central nervous system and leads to a weakening and shrinking of spasmodic cough attacks. It is necessary to exclude external stimuli that cause an attack of spasmodic cough, avoid medical manipulations, oropharyngeal examinations, etc. If possible. It is necessary to provide a full vitaminized diet. For frequent vomiting, the child should be fed. If inflammation occurs, antibiotics must be prescribed in combination with probiotics (acipol).

Treatment of severe pertussis

Walking with the child is compulsory.
One of the antibiotics - erythromycin, rulid and other macrolides, ampicillin (inside or intramuscularly up to 7 days).
With the development of pneumonia - 2 antibiotics of a wide spectrum of action parenterally.
Children of the first months of life can be placed for several days in the cuvée, creating in it a climate of subtropics (humidity 80-90%, oxygen concentration 30-40%, temperature up to 30 ° C), or use an oxygen tent.
Sedation: Seduxen in a dose of 0.3-0.5 mg / kg 3-4 times a day in combination with pipolfen, aminazine at a dose of up to 1 mg / (kg day), phenobarbital (3-5 mg / kg per day) inside. You can prescribe inside the extract of valerian, motherwort.
Lasix in a dose of 0.5-1.0 mg / kg 1-2 times a day with encephalopathy for 2-3 days, then diacarb - up to 2-5 mg / kg per day every other day.
Cavinton, trental and euphyllin for improving cerebral and pulmonary blood flow, followed by nootropics (piracetam, aminalone, etc.).
Initially, prescribe drugs that depress cough (tusuprex, sinecode, libexin, tussin plus), then, when sputum appears, - drugs that facilitate its separation (tussamag, broncholitin, pectussin, mucaltin, aniseed drops, thermopsis); inhalation with saline, mineral water.
It is recommended parenteral administration of hydrocortisone in a dose of 5 mg / (kg day) for 5 days.
Chest massage, physiotherapy, respiratory gymnastics.
The ventilator is prescribed for prolonged apnea, severe hypoxia of the brain, convulsive status. Synchronization to the device is achieved with the help of Seduxen, GHB.
The diet is mechanically sparing, easily assimilated; food is fractional; the child needs to be fed after a fit of coughing, resulting in vomiting.

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