1. GBS (Group B Streptococcus) Prophylaxis in Pregnancy
- Administer intrapartum prophylaxis if:
- GBS bacteriuria during current pregnancy.
- Previous infant with invasive GBS disease.
- Positive GBS vaginal/rectal culture in late gestation.
- Unknown GBS status with risk factors (e.g., preterm labour, prolonged ROM ≥18h, intrapartum fever).
Antibiotic Regimens:
- Penicillin G: 5 million units IV loading, then 2.5–3 million units IV every 4 hours until delivery.
- Ampicillin: 2g IV loading, then 1g IV every 4 hours until delivery.
If penicillin-allergic:
- Clindamycin 900 mg IV 8-hourly (if GBS is susceptible).
- Vancomycin 1g IV 12-hourly if allergic with high-risk of anaphylaxis or unknown susceptibility.
2. Meningococcal Exposure
Chemoprophylaxis (must be given ASAP, ideally within 24h):
3. Hib (Haemophilus influenzae type b) Prophylaxis
Indications:
- Household contact with a child <4 years old not fully vaccinated.
- Daycare/nursery outbreak.
Antibiotic:
- Rifampicin 20 mg/kg (max 600 mg) PO once daily × 4 days
4. Pertussis (Whooping Cough) Post-Exposure Prophylaxis
Indications:
- High-risk contacts (e.g. infants, pregnant women, immunocompromised).
Regimens:
Note: For infants <1 month, azithromycin is preferred due to risk of pyloric stenosis with erythromycin.
5. Sexual Exposure (Rape Survivors) – STI Prophylaxis
- Ceftriaxone 250 mg IM single dose (gonorrhoea)
- Azithromycin 1g PO single dose (chlamydia)
- Metronidazole 2g PO single dose (trichomoniasis)
- Emergency contraception if within 72 hours
- HIV PEP: See Section 6
- HBV/HAV vaccination or immunoglobulin if non-immune
6. HIV Post-Exposure Prophylaxis (PEP)
Non-Occupational Exposure (e.g. sexual, needle-sharing)
- Initiate within 72 hours of exposure
- Continue for 28 days
Preferred PEP Regimen (adults and adolescents):
- Tenofovir 300 mg + Emtricitabine 200 mg (Truvada)
- PLUS
- Dolutegravir 50 mg daily
Occupational Exposure
- As above, initiate immediately (preferably within 2 hours).
- HIV testing at 6 weeks, 3 months, and 6 months post-exposure.
7. HIV Pre-Exposure Prophylaxis (PrEP)
Indications:
- HIV-negative individuals at ongoing risk (e.g. serodiscordant couples, MSM, sex workers)
Regimen:
- Daily Truvada (TDF 300 mg + FTC 200 mg)
Follow-up:
- 3-monthly HIV testing
- Monitor renal function (creatinine)
8. HBV (Hepatitis B) Exposure
- If source is HBsAg-positive and exposed person is non-immune:
- HBIG 0.06 mL/kg IM once
- PLUS
- HBV vaccine initiation
- If partially vaccinated: Give HBIG + complete vaccine series.
- If fully vaccinated and responsive: No action.
9. HCV (Hepatitis C) Exposure
- No effective PEP currently.
- Follow-up with anti-HCV and ALT at 4–6 weeks, and HCV RNA at 12 weeks.
10. HAV (Hepatitis A) Post-Exposure
- HAV vaccine within 2 weeks of exposure if non-immune.
- Immunoglobulin (IG) may be used for high-risk persons or immunocompromised if vaccine contraindicated.
11. RSV (Respiratory Syncytial Virus) – Palivizumab
- Used for high-risk infants (e.g., prematurity, chronic lung disease, congenital heart disease).
- 15 mg/kg IM monthly during RSV season.
12. Measles, Mumps, Rubella (MMR) Exposure
- MMR vaccine within 72 hours of exposure if susceptible and not immunised.
- Measles Immunoglobulin for high-risk unvaccinated individuals within 6 days.
13. Rabies Exposure
Post-Exposure Prophylaxis:
- Clean wound thoroughly.
- Rabies vaccine: Days 0, 3, 7, and 14 (IM)
- Rabies Immunoglobulin (RIG): If Category III exposure and no prior vaccination
14. Varicella (Chickenpox) Exposure
- Varicella zoster immune globulin (VZIG): Within 96 hours for high-risk susceptible individuals.
- Acyclovir prophylaxis may be considered if VZIG unavailable.
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