Postexposure Treatment

Exposure to potentially infectious blood or body fluids includes needlesticks,
splashing of fluids in the face or eyes, and contact with body
fluids or blood through an open wound on your skin. Although intact
skin is usually a good protective barrier, irritated or chapped skin (for
example, from cold weather) can be penetrated by some viruses. If, despite
following all of the above recommendations, you are exposed to
potentially infectious blood or body fluids, certain steps can be taken
to decrease your risk for becoming ill.
• If you are exposed to HBV and have not been previously vaccinated:
Hepatitis B immunoglobulin (HBIG) should be given (5.0 ml
intramuscularly). HBIG is most effective when administered within
24 hours of a needlestick, but some protection is still afforded if it is
given in the first few days after exposure. You also should begin the
HBV vaccination regimen.
• If you are exposed to HCV: Unfortunately, there is no way to prevent
infection after HCV exposure. However, close observation is warranted,
and at the first sign of hepatitis, interferon therapy should be
instituted. Although early interferon therapy, before any signs or
symptoms of hepatitis have developed, does not prevent illness, once
signs and symptoms become apparent, interferon may prevent serious
illness.
• If you are exposed to HIV: If you have access to drugs used to treat
HIV infection, a short course of medication is often recommended
after a significant exposure. Usually, exposure to infected urine does
not warrant treatment. Recommendations for treatment usually are
related to the patient’s HIV titer and to the healthcare worker’s
degree of exposure. For example, a hollow needlestick from a patient
with a high HIV titer definitely warrants postexposure treatment—
optimally, a combination of zidovudine, 200 mg 3 times/day;
lamivudine, 150 mg 2 times/day, and indinavir, 800 mg 3 times/day.
All are given orally.
Bibliography
1. Gilbert DN, Moellering RC, Sande MA (eds): The Sanford Guide to Antimicrobial
Therapy, 29th ed. Vermont, Antimicrobial Therapy Inc., 1999, pp 112, 128.
2. www.cdc.gov/epo/mmwr (Postexposure prophylaxis).
3. www.osha.gov (Universal precautions).
4. www.who.int (World Health Organization surveillance statistics).