Prevent

Postexposure Prophylaxis

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Postexposure Prophylaxis, Post-exposure Prophylaxis

  • See Also
  1. Bloodborne Pathogen Exposure (Needlestick Injury)
  2. HIV Postexposure Prophylaxis
  3. Hepatitis B Postexposure Prophylaxis
  4. Sexually Transmitted Disease
  5. Sexual Assault
  • Pathophysiology
  • Transmission
  1. See Sexually Transmitted Disease
  2. Airborne Transmission
    1. Measles
    2. Tuberculosis
    3. Varicella Zoster Virus (Chicken Pox)
  3. Animal Bite Transmission
    1. Rabies
    2. Tetanus
  4. Bloodborne Pathogen Exposure
    1. Hepatitis B Virus
    2. Hepatitis C Virus
    3. HIV Infection
  5. Skin-to-skin transmission
    1. Varicella Zoster Virus (Chicken Pox) or Herpes Zoster (Shingles)
  6. Droplet Transmission
    1. Anthrax
    2. Diphtheria
    3. Influenza
    4. Group A Streptococcal invasive disease
    5. Meningococcemia
    6. Pertussis
    7. Plague
  7. Fecal-Oral Transmission
    1. Hepatitis A
  • Approach
  • Post-exposure
  1. Is the source patient infected with a communicable infection?
    1. Perform history, exam, labs and diagnostics if patient available and unknown status
  2. Was the source patient infectious at the time of exposure?
    1. Determine the timing of source patient's infection (onset and resolution)
  3. Characterize the exposure
    1. Mechanism of suspected transmission (e.g. bloodborne, mucous membranes, body fluids, skin contact)
    2. Frequency of exposure (e.g. frequent intercourse with the source patient)
    3. Severity of exposure (e.g. depth of needle insertion, needle gauge, volume of exposure, viral load)
  4. Is the exposed patient susceptible to the transmitted infection?
    1. Was adequate Personal Protection Equipment used?
    2. Obtain infection and Immunization history from exposed patient
    3. Consider Serology to confirm Immunity
    4. Do not delay Post-exposure Prophylaxis in serious conditions regardless of Immunity history
      1. Meningococcemia
      2. Pertussis
      3. Rabies
  5. Follow protocol specific to the exposed condition
    1. See protocol links below
    2. Obtain appropriate history, examination and labs
    3. Deliver appropriate Antimicrobial Agents
    4. Establish follow-up test per protocol
  • Management
  • Conditions with Post-exposure Prophylaxis protocols
  1. Blood-borne pathogen exposure
    1. See Bloodborne Pathogen Exposure (Needlestick Injury)
    2. HIV Postexposure Prophylaxis
    3. Hepatitis B Postexposure Prophylaxis
    4. No Hepatitis C Postexposure Prophylaxis protocol exists as of 2013
  2. Viral Infection exposure
    1. Hepatitis A Virus
    2. Varicella Zoster Virus (Chickenpox)
    3. Influenza
    4. Rabies Prophylaxis
  3. Bacterial Infection exposure
    1. Necrotizing Soft Tissue Infection (Necrotizing Streptococcal Fasciitis)
    2. Meningococcemia
    3. Pertusis
    4. Tuberculosis
    5. Tetanus (see Laceration)
  • References
  1. Bader (2013) Am Fam Physician 88(1): 25-32 [PubMed]