How should we approach adolescent and adult pertussis?

Previously considered a disease of childhood, pertussis is now also recognized as a significant problem for adolescents and adults; however, diagnosing pertussis remains problematic due to its nonspecific clinical presentation and the time delay, sensitivity/specificity, and expense of testing. To be effective, therapy is best started very early in the illness, when the illness is seldom recognized. Other than chemoprophylaxis in families with a non-immune infant, antibiotic therapy is controversial due to the ubiquitous nature of pertussis, its similarity to other respiratory infections, increased prevalence, prolonged outbreaks, and difficulties in determining true exposures in the general community.