For each of the following individuals presenting after a potential infectious exposure, select the most appropriate guideline-concordant prophylactic regimen.
- A 28-year-old nurse who sustained a deep, bloody needlestick injury from a patient with untreated HIV.Tenofovir-emtricitabine plus raltegravir or dolutegravir for 28 days
- A 19-year-old university student who spent several hours studying in close proximity with a classmate newly diagnosed with meningococcal meningitis.A single dose of oral ciprofloxacin or intramuscular ceftriaxone
- A 35-year-old camper who removed an engorged Ixodes scapularis tick from their leg after a 3-day camping trip in Connecticut.A single dose of oral doxycycline
- A 12-year-old boy bitten on the finger by a bat found in his bedroom, which subsequently escaped out the window.Human rabies immune globulin and a 4-dose series of rabies vaccine
Answer
The exposures match with their respective evidence-based prophylaxis protocols: the nurse exposed to HIV requires a 3-drug ART regimen for 28 days; the student exposed to meningococcus requires single-dose ciprofloxacin or ceftriaxone; the camper with a prolonged tick attachment requires single-dose doxycycline; and the boy bitten by a bat requires both rabies immune globulin and active vaccination.
Each specific exposure mechanism carries a well-defined risk for a particular pathogen, necessitating a targeted prophylactic approach. HIV exposure requires 28 days of triple-therapy ART. Meningococcal exposure requires clearance of nasopharyngeal carriage with agents like ciprofloxacin. Lyme disease prophylaxis requires a single dose of doxycycline when tick attachment exceeds 36 hours. Unprovoked bat bites require complete rabies post-exposure prophylaxis with both passive and active immunity.
Step-by-Step Solution
Key Concept
Post-exposure prophylaxis (PEP) protocols for high-risk infectious exposures