Therapeutic Challenges and a Public Health Approach to the Treatment of Pertussis

Whooping cough, caused by the Gram-negative bacterium Bordetella pertussis, is a highly contagious acute respiratory infection that is reemerging in several countries with high vaccination coverage, with more severe cases occurring in young infants. The objective of this study was to synthesize the current evidence on therapeutic challenges and public health strategies for controlling the disease. A narrative literature review was conducted in the PubMed database, using the search terms “Whooping Cough” and “Therapeutics” combined with the Boolean operator AND. The results indicate a shift in the disease burden toward school-aged children, adolescents, and adults, who have become the primary reservoir for transmission to infants, as well as the limitation of acellular parenteral vaccines in inducing a mucosal immune response. The emergence of resistance to macrolides, associated with the 23S rRNA A2047G mutation, has led to the use of sulfamethoxazole-trimethoprim and beta-lactams as alternatives, while severe cases require intensive support, such as exchange transfusion or plasmapheresis. New therapeutic targets against the pertussis toxin are currently under development. In the context of public health, key measures include maternal vaccination, the administration of booster doses, contact prophylaxis, and intranasal vaccines. It is concluded that the control of pertussis requires the integration of early diagnosis, appropriate antibiotic therapy, and comprehensive immunization strategies capable of protecting vulnerable populations and interrupting community transmission.