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Letter to the Editor
Editor, – In their article on pertussis prophylaxis (Aust Prescr 2012;35:82-4) the authors recommended erythromycin 10 mg/kg (maximum 250 mg) every six hours for children aged two months or more. They make no antibiotic recommendation for children aged one month.
In 1985, good results were observed for pertussis with erythromycin estolate suspension compared to poor results with erythromycin ethyl succinate.1 In the only randomised comparison of the two esters,2 13 of 93 children were cured in the estolate group compared to only 4 of 97 in the ethyl succinate group (p=0.016). Ethyl succinate was given in a dose of 20 mg/kg every eight hours, which is equivalent to 15 mg/kg every six hours rather than the 10 mg/kg every six hours as recommended in the article.
Unfortunately, only erythromycin ethyl succinate suspension is available in Australia. Given the availability of azithromycin, clarithromycin and trimethoprim-sulfamethoxazole, I suggest that erythromycin ethyl succinate suspension should not be recommended for pertussis prophylaxis – and certainly not in a dose of only 10 mg/kg every six hours.
Specialist in Intensive Care
Royal Children’s Hospital
Professor of Critical Care Medicine
University of Melbourne
- Bass JW. Erythromycin for pertussis: probable reasons for past failures. Lancet 1985;2:147.
- Hoppe JE. Comparison of erythromycin estolate and erythromycin ethylsuccinate for treatment of pertussis. The Erythromycin Study Group. Pediatr Infect Dis J 1992;11:189-93.
- Pertussis. In: The Australian Immunisation Handbook. 9th ed. Canberra: Australian Government Department of Health and Ageing; 2008. p 227-39 .
- NSW Health. Factsheet: whooping cough (pertussis) [cited 2012 Nov 8].
- Victorian Department of Health. Pertussis (whooping cough) - advice for clinicians. 2009 [cited 2012 Nov 8].