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
  • 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 pregancy

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 7d
  • Direct exposure to pt'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

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