百日咳

服用大环内酯类抗生素的＜1月龄的婴儿需警惕出现肥厚性幽门狭窄（IHPS)等严重副作用。迄今为止，仅有散发病例报道出现IHPS。

研究显示，在疾病早期进行治疗最有效（发生阵发性咳嗽2周内）。[33]Centers for Disease Control and Prevention. Pertussis (whooping cough): information for clinicians. July 2014. http://www.cdc.gov (last accessed 14 March 2017).http://www.cdc.gov/pertussis/clinical/index.html

在咳嗽出现后3周才予以药物干预，则药物疗效极其有限。

一线治疗选择为大环内酯。[33]Centers for Disease Control and Prevention. Pertussis (whooping cough): information for clinicians. July 2014. http://www.cdc.gov (last accessed 14 March 2017).http://www.cdc.gov/pertussis/clinical/index.html[56]Alvarez-Elcoro S, Enzler MJ. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc. 1999;74:613-634.http://www.ncbi.nlm.nih.gov/pubmed/10377939?tool=bestpractice.com[57]Halperin SA, Bortolussi R, Langley JM, et al. A randomized, placebo-controlled trial of erythromycin estolate chemoprophylaxis for household contacts of children with culture-positive Bordetella pertussis infection. Pediatrics. 1999;104:E42.http://www.ncbi.nlm.nih.gov/pubmed/10506267?tool=bestpractice.com对大于6个月的百日咳患儿而言，阿奇霉素和克拉霉素与红霉素疗效相当，耐受性更好，副作用更少且更温和。[44]Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases. Chapter 10: pertussis. 2015. http://www.cdc.gov (last accessed 14 March 2017).http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.pdf红霉素作为阿奇霉素和克拉霉素的备选药物。对于耐大环内酯类药物的百日咳，该药无效。 对于有大环内酯类明显禁忌证或不能耐受大环内酯类药物的人群，同样也不适用该药。

对于有明显禁忌证或不能耐受大环内酯类药物的患儿，推荐使用甲氧嘧啶/磺胺甲基异恶唑。该药也适用于治疗疑似或确诊的耐大环内酯类药物的百日咳患者。对于小于6周以下的婴儿，该药禁用（某些国家如美国，为小于2个月的婴儿）。[29]Gregory DS. Pertussis: a disease affecting all ages. Am Fam Physician. 2006;74:420-426.http://www.ncbi.nlm.nih.gov/pubmed/16913160?tool=bestpractice.com

在咳嗽出现后3周才予以药物干预，则药物疗效极其有限。

一线治疗选择为大环内酯。[33]Centers for Disease Control and Prevention. Pertussis (whooping cough): information for clinicians. July 2014. http://www.cdc.gov (last accessed 14 March 2017).http://www.cdc.gov/pertussis/clinical/index.html[56]Alvarez-Elcoro S, Enzler MJ. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc. 1999;74:613-634.http://www.ncbi.nlm.nih.gov/pubmed/10377939?tool=bestpractice.com[57]Halperin SA, Bortolussi R, Langley JM, et al. A randomized, placebo-controlled trial of erythromycin estolate chemoprophylaxis for household contacts of children with culture-positive Bordetella pertussis infection. Pediatrics. 1999;104:E42.http://www.ncbi.nlm.nih.gov/pubmed/10506267?tool=bestpractice.com在治疗百日咳时，阿奇霉素和克拉霉素较红霉素而言疗效相当，但更易耐受，且副作用更少、更轻。[44]Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases. Chapter 10: pertussis. 2015. http://www.cdc.gov (last accessed 14 March 2017).http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.pdf红霉素作为阿奇霉素和克拉霉素的备选药物。对于耐大环内酯类药物的百日咳，该药无效。 对于有大环内酯类明显禁忌证或不能耐受大环内酯类药物的人群，同样也不适用该药。

但对大环内酯类药物有明显禁忌或不能耐受时，推荐用甲氧苄啶/磺胺甲噁唑进行百日咳治疗。该药也适用于治疗疑似或确诊的耐大环内酯类药物的百日咳患者。[33]Centers for Disease Control and Prevention. Pertussis (whooping cough): information for clinicians. July 2014. http://www.cdc.gov (last accessed 14 March 2017).http://www.cdc.gov/pertussis/clinical/index.html[29]Gregory DS. Pertussis: a disease affecting all ages. Am Fam Physician. 2006;74:420-426.http://www.ncbi.nlm.nih.gov/pubmed/16913160?tool=bestpractice.com

在咳嗽出现后3周才予以药物干预，则药物疗效极其有限。

对于孕32周以上的晚期妊娠孕妇，如在既往5年内未进行免疫接种，建议进行接触后药物预防。[4]Public Health England. Guidelines for the public health management of pertussis in England. December 2016. http://www.gov.uk (last accessed 14 March 2017).https://www.gov.uk/government/publications/pertussis-guidelines-for-public-health-management

对孕妇，红霉素首选。

孕妇不推荐使用克拉霉素和阿奇霉素。甲氧苄啶/磺胺甲噁唑对孕妇及哺乳期妇女禁用。[4]Public Health England. Guidelines for the public health management of pertussis in England. December 2016. http://www.gov.uk (last accessed 14 March 2017).https://www.gov.uk/government/publications/pertussis-guidelines-for-public-health-management

在咳嗽出现后3周才予以药物干预，则药物疗效极其有限。