Are there any data from Germany about the sensitivity of pertussis strains to macrolides, trimethoprim–sulfamethoxazole, and tetracyclines, which are recommended for therapy, respectively prophylaxis (presumably post-exposure prophylaxis)? From the United States, erythromycin resistant strains of Bordetella pertussis have been reported (1). In vitro, gyrase inhibitors fluoroquinolones) have been found to be highly active, even for macrolide resistant strains; they are therefore an alternative treatment option at least in adults (2). However, a word of warning is in order against the uncritical use of azithromycin because of possible selection of resistant pneumococci. This has occurred after only a single dose of azithromycin (3). Since resistant strains exist, cultures and sensitivity testing should be the way forward.
Footnotes
Conflict of interest statement
The author has received honoraria as a speaker and adviser from Sanofi-Aventis, Janssen-Cilag, and Pohl-Boskamp.
References
- 1.Bartkus JM, Juni BA, Ehresmann K, Miller CA, Sanden GN, Cassiday PK, et al. Identification of a mutation associated with erythromycin resistance in Bordetella pertussis: implications for surveillance of antimicrobial resistance. J Clin Microbiol. 2003;41:1167–1172. doi: 10.1128/JCM.41.3.1167-1172.2003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Bourgeois N, Ghnassia JC, Doucet-Populaire F. In vitro activity of fluoroquinolones against erythromycin-susceptible and -resistant Bordetella pertussis. J Antimicrob Chemother. 2003;51:742–743. doi: 10.1093/jac/dkg145. [DOI] [PubMed] [Google Scholar]
- 3.Leach AJ, Shelby-James TM, Mayo M, Gratten M, Laming AC, Currie BJ, et al. A prospective study of the impact of community-based Azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae. Clin Infect Dis. 1997;24:356–362. doi: 10.1093/clinids/24.3.356. [DOI] [PubMed] [Google Scholar]
- 4.Riffelmann M, Littmann M, Hellenbrand W, Hülße C, Wirsing von König CH. Pertussis: Not Only a Disease of Childhood. Dtsch Arztebl Int. 2008;105(37):623–628. doi: 10.3238/arztebl.2008.0623. [DOI] [PMC free article] [PubMed] [Google Scholar]