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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Victims of Physical or Sexual Abuse : Sexual Assault Medication Prophylaxis (Red Book)

Antimicrobial prophylaxis2 is recommended to include an empiric regimen to prevent Chlamydia trachomatis infection, gonorrhea, trichomoniasis, and bacterial vaginosis

For gonorrhea3Ceftriaxone, 125 mg, intramuscularly, in a single dose
OR
Cefixime, 400 mg orally, in a single dose
OR
Ciprofloxacin, 500 mg, orally, in a single dose
OR
Ofloxacin, 400 mg, orally, in a single dose
OR
Levofloxacin, 250 mg, orally, in a single dose
PLUS
For C trachomatis infectionAzithromycin, 1 g, orally, in a single dose
OR
Doxycycline, 100 mg, orally, twice a day for 7 days (for those >= 8 years of age and not pregnant)
PLUS
For trichomoniasis and bacterial vaginosisMetronidazole, 2 g, orally, in a single dose
PLUS
For hepatitis B virus infectionHepatitis B virus immunization at time of initial examination, if not fully immunized. Follow-updoses of vaccine should be administered 1-2 and 4-6 mo after the first dose.
PLUS
For human immunodeficiency virus infection2Consider offering prophylaxis for HIV, depending on circumstances (see Table 3.27, p 394)


Emergency Contraception4
Plan B (levonorgestrel 0.75 mg), 2 tablets at the same time

OR

Oral contraceptive pills each containing 20 or 30 µg of ethinyl estradiol plus levonorgestrel 0.1 mg or 0.15 mg or 0.3 mg norgestrel: each of 2 doses must be given 12 h apart. Each dose must contain at least 100-120 µg of ethinyl estradiol and 0.5 to 0.6 mg levonorgestrel or 1 mg norgestrel.

PLUS

An antiemetic (eg, meclizine, 25-50 mg, once before the first dose of oral contraceptive)



1 Source: Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines - 2006. MMWR Recomm Rep. 2006; in press (see www.cdc.gov/mmwr)

2 See text for discussion of prophylaxis for human immunodeficiency virus (HIV) infection after sexual abuse or assault.

3 A single dose of a fluoroquinolone can be used in areas of low prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae. Because of resistance, fluoroquinolones should not be used if infection is acquired in Asia, the Pacific Islands (including Hawaii), California, and other areas with increased fluoroquinolone-resistant N gonorrhoeae. Quinolones should not be used in pregnant women.

4 The patient should have a negative pregnancy test result before emergency contraception is given. Although emergency contraception is most effective if taken within 72 hours of event, data suggest it is effective up to 120 hours.


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