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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-.

Cochrane Database of Systematic Reviews: Plain Language Summaries.

Treatment of the cough in whooping cough

This version published: 2012; Review content assessed as up-to-date: January 12, 2012.

Plain language summary

Whooping cough, or pertussis, is an infectious bacterial disease. It affects infants and small children and can be life‐threatening in unimmunised infants younger than three months of age. Infants with whooping cough experience severe bouts of coughing and vomiting which can lead to dehydration and difficulty breathing. Routine vaccination can prevent illness and protect infants and children against death and admission to hospital.

Whooping cough also affects older children and adults and new vaccine strategies are being developed to improve coverage, as neither immunisation nor natural infection result in lifelong immunity. New improved laboratory methods and higher awareness amongst doctors have helped improve surveillance of community outbreaks. These methods have also helped improve diagnosis as antibiotics can limit the course of the disease if given in the early stage of the illness. In the later stages, antibiotics have little individual benefit and treatment with corticosteroids, salbutamol, pertussis specific immunoglobulin (antibodies to increase the body's resistance) or antihistamines has been used in an attempt to reduce the cough while the disease runs its course.

We reviewed 10 studies involving children and adults with whooping cough. Only six of these studies, which included a total of 196 patients, reported their results in enough detail for us to assess them. The studies involved different types of interventions (excluding antibiotics and vaccines) and found that no trial provided enough evidence to determine whether the drugs used can reduce the cough in whooping cough. The risk of side effects was similar in patients treated with pertussis‐specific immunoglobulin or placebo.


Background: The worldwide incidence of whooping cough (pertussis) has been estimated at 48.5 million cases and nearly 295,000 deaths per year. In low‐income countries, the case‐fatality rate among infants may be as high as 4%. Much of the morbidity of whooping cough in children and adults is due to the effects of the paroxysmal cough. Cough treatments proposed include corticosteroids, beta 2‐adrenergic agonists, pertussis‐specific immunoglobulin, antihistamines and possibly leukotriene receptor antagonists (LTRAs).

Objectives: To assess the effectiveness and safety of interventions to reduce the severity of paroxysmal cough in whooping cough in children and adults.

Search methods: We updated searches of the Cochrane Central Register of Controlled Trials (CENTRAL Issue 2, 2012), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, the Database of Abstracts of Reviews of Effects (DARE Issue 2, 2012) accessed from The Cochrane Library, MEDLINE (1950 to January 2012), EMBASE (1980 to January 2012), AMED (1985 to January 2012), CINAHL (1980 to January 2012) and LILACS (January 2012). We searched Current Controlled Trials to identify trials in progress.

Selection criteria: We selected randomised controlled trials (RCTs) and quasi‐RCTs of any intervention (excluding antibiotics and vaccines) to suppress the cough in whooping cough.

Data collection and analysis: Two review authors (SB, MT) independently selected trials, extracted data and assessed the quality of each trial for this review in 2009. Two review authors (SB, KW) independently reviewed additional studies identified by the updated search in 2012. The primary outcome was frequency of paroxysms of coughing. Secondary outcomes were frequency of vomiting, frequency of whoop, frequency of cyanosis (turning blue), development of serious complications, mortality from any cause, side effects due to medication, admission to hospital and duration of hospital stay. 

Main results: Ten trials were included of varying sample sizes (N = 9 to 135) from high‐income countries. Study quality was generally poor. Included studies did not show a statistically significant benefit for any of the interventions. Only six trials including a total of 196 participants reported data in sufficient detail for analysis. Diphenhydramine did not change coughing episodes; the mean difference (MD) of coughing spells per 24 hours was 1.9; 95% confidence interval (CI) ‐ 4.7 to 8.5. One study on pertussis immunoglobulin reported a possible mean reduction of ‐3.1 whoops per 24 hours (95% CI ‐6.2 to 0.02) but no change in hospital stay (MD ‐0.7 days; 95% CI ‐3.8 to 2.4). Dexamethasone did not show a clear decrease in length of hospital stay (MD ‐3.5 days; 95% CI ‐15.3 to 8.4) and salbutamol showed no change in coughing paroxysms per 24 hours (MD ‐0.2; 95% CI ‐4.1 to 3.7). Only one trial comparing pertussis immunoglobulin versus placebo reported data on adverse events: 4.3% in the treatment group (rash) versus 5.3% in the placebo group (loose stools, pain and swelling at injection site).

Authors' conclusions: There is insufficient evidence to draw conclusions about the effectiveness of interventions for the cough in whooping cough.

Editorial Group: Cochrane Acute Respiratory Infections Group.

Publication status: New search for studies and content updated (no change to conclusions).

Citation: Bettiol S, Wang K, Thompson MJ, Roberts NW, Perera R, Heneghan CJ, Harnden A. Symptomatic treatment of the cough in whooping cough. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD003257. DOI: 10.1002/14651858.CD003257.pub4. Link to Cochrane Library. [PubMed: 22592689]

Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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