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[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 (300mg of tenofovir with 200mg of emtricitabine) once daily OR
- Zidovudine–lamivudine (Combivir) one tablet (300mg of zidovudine with 150mg of lamivudine) twice daily
- this regimen is preferred in pregnancy
3 drug Expanded[2]
- Ritonavir–lopinavir (Kaletra) PLUS either tenofovir–emtricitabine or zidovudine–lamivudine)
- Two tablets (50mg of ritonavir with 200mg of lopinavir per tablet) twice daily, or four tablets once daily
- Ritonavir plus atazanavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine
- 100mg of ritonavir plus 300mg of atazanavir once daily
- Ritonavir plus darunavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine)
- 100mg of ritonavir plus two tablets, each containing 400mg of darunavir, 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
- Ciprofloxacin 500mg PO x1
- Do not use in patients with recent travel to Saudi Arabia[3]
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)
References
- ↑ Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e
- ↑ 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
- ↑ https://www.cdc.gov/mmwr/volumes/73/wr/mm7322e1.htm