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To the Editor: The study by Dr Little and colleagues¹ showed that the provision of antibiotics did not alter cough duration or other primary outcomes in patients with acute lower respiratory tract infection. Although I agree with their overall conclusion, I noted that of the 562 patients who completed symptom diaries and the 78 patients who provided information about both symptom duration and severity, 25% had cough lasting 17 days or more. This raises the possibility that some of the patients may have had pertussis.

The incidence of pertussis among the nonpediatric population is increasing in the United States and other developed countries.^2-4 Approximately 25% of cases of cough lasting more than 21 days in adolescents and adults are associated with Bordetella pertussis infection.² This is a significant public health problem because adolescents and adults with B pertussis infection are the greatest source of its spread to infants; this group . . . [Full Text of this Article]

Masahito Jimbo, MD, PhD, MPH
mjimbo@med.umich.edu
Department of Family Medicine
University of Michigan
Ann Arbor

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