Case 2: Initial Evaluation and Postexposure Prophylaxis

Question | Discussion | References | CME Credit

Authors: Christopher Behrens, MD
David H. Spach, MD

Case last updated: January 18, 2008

While on call on a Saturday night, a 28-year-old medical resident sustains a needlestick injury to his gloved palm while drawing blood using a 21-gauge phlebotomy needle. The source patient is a 35-year-old female hospitalized for newly diagnosed AIDS and Pneumocystis pneumonia (PCP). The resident presents to employee health the following Monday morning (approximately 36 hours following the exposure) for evaluation. When asked, he denies that the injury was deep; he does not know if the needle was visibly bloody at the time he was injured. Examination reveals only a pinpoint puncture wound on his left palm. He has no known medical problems and does not take any medications.

How would you advise this resident regarding postexposure prophylaxis (PEP)?

	PEP is not indicated at this time because too much time has elapsed since the exposure.
	PEP should be initiated if viral load testing on the source patient reveals a high viral load.
	A two-drug PEP regimen should be initiated immediately.
	A three-drug PEP regimen should be initiated immediately.