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PURPOSE: To evaluate the effectiveness and safety of oral levofloxacin verse trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of macrolides-resistant pertussis in pediatric outpatients. METHODS: A prospective observational study was conducted at a pediatric pertussis outpatient clinic during the pertussis outbreak in 2024. For eligible children with PCR-confirmed pertussis, administration of either levofloxacin (8-10 mg/kg/dose, once or twice daily) or TMP-SMX (4-20 mg/kg/dose, twice daily) depended on parents' preference. Effectiveness and safety were evaluated for the 5-14 days duration of levofloxacin and TMP-SMX treatment in terms of alleviation of cough symptoms, bacteriologic clearance of Bordetella pertussis and adverse effects. RESULTS: Among 193 enrolled pertussis cases, eighty-four (43.53 %) received levofloxacin and 109 (56.48 %) received TMP-SMX. After completing treatment, paroxysmal cough resolved or improved in 96.43 % of levofloxacin group and 94.50 % (103/109) of TMP-SMX group (p = 0.554). Nocturnal cough resolved or improved in 98.81 % of levofloxacin group and in 98.17 % of TMP-SMX group (p = 0.057). There was no significant difference in bacteriologic clearance rate between levofloxacin group and TMP-SMX group determined by PCR (92.00 % vs 87.06 %, p = 0.378) and culture (100 % vs 100 %, p > 0.378). Symptom resolution rate did not differ significantly among patients treated for 5 or 7 days with either levofloxacin or TMP-SMX. Adverse events were reported in 9.2 % of TMP-SMX-treated patients and 2.4 % of levofloxacin-treated patients (p < 0.05). Drug rash was reported in nine (8.26 %) TMP-SMX-treated patients. CONCLUSIONS: Oral levofloxacin showed a comparable clinical effectiveness and a favorable safety profile to TMP-SMX for the treatment of non-severe pertussis with a 5-7 days course in children.
Wang et al. (Thu,) studied this question.