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Antibiotics 'do not change the natural history of pertussis'

There is no evidence antibiotics can change the natural history of whooping cough, GPs have been advised in a newly published review from the Cochrane Collaboration.

But the RCGP warned it could be regarded as ‘unethical' to withhold antibiotic treatment from patients with whooping cough.

The report, which reviewed evidence from 13 clinical trials on 2,197 adults and children, accepted that antibiotic drugs can kill the B. pertussis bacteria in sufferers, but said ‘they did not alter the subsequent clinical course of the illness'.

And it said antibiotic therapy could be ‘inconvenient and prolonged' with poor compliance.

The report said short courses of antibiotics, such as azithromycin over three to four days, were as effective as long courses.

Dr Ian Williamson, an infectious diseases specialist at Southampton University, said: ‘My concern would be to target patients at risk of complications.

‘Many patients are probably okay untreated.'

RCGP immunisation spokesperson Dr George Kassianos said: ‘The Cochrane review shows it's unnecessary to prescribe a two-week course of erythromycin. One week is just as good, and easier to take.'

But he stressed: ‘Under the current climate and knowledge, it may be deemed unethical not to prescribe an appropriate antibiotic to a patient with proven or strongly suspected pertussis infection.'

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