Post exposure prophylaxis antibiotics

Hepatitis B

Hepatitis B Post-Exposure Prophylaxis

Treatment is generally initiated after coordination with occupational health and infectious disease service and based the the exposed patient's vaccination history

Unvaccinated

• If the source is HBsAg(+) then give HBIG x1 and initiate HBV vaccine in two separate sites
• If source is HGsAG(-) then start the HBV vaccine series
• If source blood is unavailable and high risk then give HBIG x1 initiate the HBV series
  • If source blood is low risk and unavailable then begin HBV series

Previously vaccinated non responder (one series)

Non responder status is defined as anti-has <10mIU/mL

• If the source is HBsAg(+) then give HBIG x 1 and begin revaccination series
  • Can also opt to perform second HBIG administration in one month
• If source is HBsAg(-) then no treatment is needed
• If source blood is unavailable and high risk then treat as if HBsAg(+)

Previously vaccinated non responder (two series)

Non responder status is defined as anti-has <10mIU/mL

• If the source is HBsAg(+) then give HBIG x2 and no HBV series
• If source is HGsAG(-) then no treatment is needed
• If source blood is unavailable then initiate the HBV series

Treatment Dosing

No contraindications for pregnancy or breast feeding

• HBIG 0.06 mL/kg IM
  • Give in opposite arm from hepatitis B vaccine if patient also receiving vaccine
• Vaccination series: HBV vaccine options:
  • Engerix-B 20mcg IM
  • Recombivax HB 10mcg IM

HIV

Percutaneous Injuries

Superficial wound or solid needle

• If HIV+ source asymptomatic or if viral load <15000 RNA/mL give basic regimen
• If HIV+ with AIDS, acute seroconversion or high viral load give expanded regimen
• If HIV status unknown then no PEP (consider PEP if possible HIV risk from source)

Deep wound or hollow needle

• If HIV+ source asymptomatic or if viral load <15000 RNA/mL give expanded regimen
• If HIV+ with AIDS, acute seroconversion or high viral load give expanded regimen
• If HIV status unknown then no PEP (consider PEP if possible HIV risk from source)

Mucous Membrane Exposure

Small volume (few drops)

• If HIV+ source asymptomatic or if viral load <15000 RNA/mL consider basic regimen
• If HIV+ with AIDS, acute seroconversion or high viral load give basic regimen
• If HIV status unknown then no PEP (consider PEP if possible HIV risk from source)

Large volume (splash)

• If HIV+ source asymptomatic or if viral load <15000 RNA/mL give basic regimen
• If HIV+ with AIDS, acute seroconversion or high viral load give expanded regimen
• If HIV status unknown then no PEP (consider PEP if possible HIV risk from source)

Treatment Regimens

Post exposure prophylaxis is not recommended 72hrs post exposure All regimens are 28 days duration.

First Choice

• Tenofovir-Emtricitabine (Truvada) one tablet (300mg of tenofovir with 200mg of emtricitabine) once daily

PLUS

• Raltegravir (RAL)(400 mg) twice daily or Dolutegravir (DTG)(50 mg) once daily

Second Choice

This alternative drug choice is reserved for situations of HIV resistance or under infectious disease guidance

• Tenofovir-Emtricitabine (Truvada) one tablet (300mg of tenofovir with 200mg of emtricitabine) once daily

PLUS

• Darunavir (DRV)(800 mg) once daily with Ritonavir (RTV)(100 mg) once daily

Neisseria meningitidis

Only for meningococcus exposure

Indications

• Household contacts
• School or day care contacts in previous 7 days
• Direct exposure to patient's secretions (kissing, shared utensils or toothbrush)
• Intubation without facemark

Prophylaxis regimen

Either of the options are acceptable

• Rifampin 600mg PO BID x2d
  • 5mg/kg PO if < 1 month old
  • 10mg/kg PO ≥ 1 month old
• Ceftriaxone 250mg IM x1
  • 125mg IM if ≤ 15 years old
  • Ceftriaxone should be used for pregnant patients
• Azithromycin
  • Pediatric: 10 mg/kg (maximum 500 mg), po x 1
  • Adult: 500 mg, po x 1
• Ciprofloxacin 500mg PO x1
  • No longer recommended as an option in California
  • Do not use in patients with recent travel to Saudi Arabia

See Also

Antibiotics by diagnosis

• Bone and joint antibiotics
• Cardiovascular antibiotics
• ENT antibiotics
• Eye antibiotics
• GI antibiotics
• GU antibiotics
• Neuro antibiotics
• OB/GYN antibiotics
• Pulmonary antibiotics
• Skin and soft tissue antibiotics
• Bioterrorism antibiotics
• Environmental exposure antibiotics
• Immunocompromised antibiotics
• Post exposure prophylaxis antibiotics
• Pediatric antibiotics
• Sepsis antibiotics
• Arthropod and parasitic antibiotics

For antibiotics by organism see Microbiology (Main)