Absence of Macrolide-Resistant Mutations in Bordetella pertussis in Antananarivo (Madagascar) and Cambodia During the Last Pertussis Cycle Before the COVID-19 Pandemic - Scorecard - MDSpire
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Absence of Macrolide-Resistant Mutations in Bordetella pertussis in Antananarivo (Madagascar) and Cambodia During the Last Pertussis Cycle Before the COVID-19 Pandemic
Clinical Scorecard: Lack of Macrolide-Resistant Bordetella pertussis Mutations Observed in Antananarivo (Madagascar) and Cambodia During the Final Pertussis Cycle Prior to the COVID-19 Outbreak
At a Glance
Category
Detail
Condition
Pertussis (whooping cough) caused by Bordetella pertussis
Key Mechanisms
Macrolide resistance caused by A2047G mutation in 23s rRNA gene
Target Population
Infants aged ≤6 months with persistent cough and pertussis symptoms
Care Setting
Hospital-based settings in Madagascar and Cambodia
Key Highlights
No macrolide-resistant Bordetella pertussis (MRBP) strains detected in Madagascar and Cambodia before COVID-19 pandemic.
Macrolides remain first-line treatment reducing symptoms and transmission when given early.
Rising MRBP cases reported in China, and recently in Europe and Asia, highlighting need for enhanced surveillance.
Guideline-Based Recommendations
Diagnosis
Use PCR testing of nasopharyngeal swabs to detect Bordetella pertussis.
Sequence 23s rRNA gene to identify A2047G mutation associated with macrolide resistance.
Management
Administer macrolide antibiotics (erythromycin, clarithromycin, azithromycin, roxithromycin) as first-line treatment.
Strengthen vaccination and booster coverage to reduce bacterial circulation and antibiotic use.
Monitoring & Follow-up
Implement molecular surveillance for MRBP via culture or gene sequencing including whole-genome sequencing when feasible.
Send samples to national reference centers if local laboratory capacity is limited.
Risks
Increased macrolide use during COVID-19 pandemic may enhance selective pressure for MRBP emergence.
International travel facilitates global spread of resistant strains.
Patient & Prescribing Data
Infants ≤6 months with pertussis symptoms in Madagascar and Cambodia (2017-2019)
No MRBP detected in analyzed samples; macrolides remain effective first-line therapy in these settings before COVID-19.
Clinical Best Practices
Early administration of macrolides to reduce symptoms and transmission.
Sustain and expand molecular surveillance for macrolide resistance mutations.
Enhance vaccination and booster programs to decrease pertussis incidence and antibiotic reliance.
Consider sending samples to reference labs for resistance testing in resource-limited settings.
Monitor global epidemiology for emerging MRBP strains linked to international travel.
