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
• 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

2 drug Basic

• 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

• 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

• 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

Authors

Daniel Ostermayer, Ross Donaldson, Neil Young