Post exposure prophylaxis antibiotics: Difference between revisions

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==Hepatitis B==
==Hepatitis B==
{{Hepatitis B post exposure prophylaxis}}
{{Hepatitis B post exposure prophylaxis}}
==HIV==
===Exposure management by wound type===
{{HIV post-exposure by wound}}
===Treatment Regimens==
===2 drug Basic<ref name="NEJM">Landovitz RJ, Currier JS. Postexposure prophylaxis for HIV infection. N Eng J Med. 2009 Oct 29; 361(18): 1768-75. [http://www.uphs.upenn.edu/ppmc_emergency/PPMC%20Bookmarks/2012%20LLSA%20Articles/Postexposure%20Prophylaxis%20for%20HIV.pdf PDF]</ref>===
*Tenofovir-Emtricitabine (Truvada) one tablet (300 mg of tenofovir with 200 mg of emtricitabine) once daily OR
*Zidovudine–lamivudine (Combivir) one tablet (300 mg of zidovudine with 150 mg of lamivudine) twice daily
**this regimen is preferred in pregancy
===3 drug Expanded<ref name="NEJM"></ref>===
*Ritonavir–lopinavir (Kaletra) PLUS either tenofovir–emtricitabine or zidovudine–lamivudine)
**Two tablets (50 mg of ritonavir with 200 mg of lopinavir per tablet) twice daily, or four tablets once daily
*Ritonavir plus atazanavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine
**100 mg of ritonavir plus 300 mg of atazanavir once daily
*Ritonavir plus darunavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine)
**100 mg of ritonavir plus two tablets, each containing 400 mg of darunavir, once daily
==See Also==
==See Also==
{{Antibiotics by diagnosis navigation}}
{{Antibiotics by diagnosis navigation}}

Revision as of 16:16, 22 May 2016

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[1]

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

Exposure management by wound type

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

2 drug Basic[2]

  • Tenofovir-Emtricitabine (Truvada) one tablet (300 mg of tenofovir with 200 mg of emtricitabine) once daily OR
  • Zidovudine–lamivudine (Combivir) one tablet (300 mg of zidovudine with 150 mg of lamivudine) twice daily
    • this regimen is preferred in pregancy

3 drug Expanded[2]

  • Ritonavir–lopinavir (Kaletra) PLUS either tenofovir–emtricitabine or zidovudine–lamivudine)
    • Two tablets (50 mg of ritonavir with 200 mg of lopinavir per tablet) twice daily, or four tablets once daily
  • Ritonavir plus atazanavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine
    • 100 mg of ritonavir plus 300 mg of atazanavir once daily
  • Ritonavir plus darunavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine)
    • 100 mg of ritonavir plus two tablets, each containing 400 mg of darunavir, once daily

See Also

Antibiotics by diagnosis

For antibiotics by organism see Microbiology (Main)

References

  1. ↑ Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e
  2. ↑ 2.0 2.1 Landovitz RJ, Currier JS. Postexposure prophylaxis for HIV infection. N Eng J Med. 2009 Oct 29; 361(18): 1768-75. PDF
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