A 6-month-old infant is brought to the emergency department with a 3-day history of paroxysmal cough with post-tussive emesis, low-grade fever, and rhinorrhea. The infant has received only one dose of DTaP vaccine. Laboratory results show leukocytosis with lymphocytosis. Which of the following is the BEST next step in management?
Discharge with instructions for supportive care and follow-up
Initiate azithromycin and admit for respiratory monitoring
Perform chest X-ray and initiate albuterol nebulization
Obtain nasopharyngeal PCR and await results before treatment
Initiate azithromycin because macrolides are first-line therapy for Bordetella pertussis. Infants younger than six months, especially those incompletely immunized, are at high risk for apnea and rapid deterioration, so hospital admission for continuous cardiorespiratory monitoring is recommended. Waiting for PCR confirmation delays therapy, bronchodilators do not relieve the toxin-mediated cough, and outpatient management is unsafe in this age group.
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BCEN CEN
Environment and Toxicology Emergencies, and Communicable Diseases
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