Prophylaxis

Definition

This word refers to measures that are taken in order to prevent health problems or disease instead of treating or curing an existing condition. These measures are also referred to as “preventative care.” They may also be used to minimize the symptoms of a person who has been exposed to a health hazard or infectious agent or stop an outbreak. It is a medical term that comes from the Greek word meaning “to guard against.” It is a reference to the fact that prophylaxis is intended to provide protections for those who are at risk for disease.

Types

Although there are many different prophylaxis for different diseases and health problems there are two main types, which are:

• Primary – this is any type of measure that is taken to prevent an illness or health problem before it happens. This could include brushing your teeth to prevent gum disease or getting a vaccination to prevent an illness. These measures could also include lifestyle changes like exercise and diet, medications, screening tests, physical exams, emergency preparedness, etc.
• Secondary – this is any procedure that helps to prevent infection after the person has been exposed to a disease. It is also used to ease symptoms that are associated with a health condition or illness. For example, if health workers are exposed to HIV, they may be given an antiretroviral medication to prevent this virus from becoming an active infection. It can also include radiation treatment after a surgery to remove a tumor to prevent the cancer from reoccurring, medication for pregnant women to prevent vomiting when experiencing severe morning sickness, etc.

Prophylaxis dosage

This is the treatment that is given with the intent of preventing an illness from occurring. They are often lower than the medication dosages that are required to treat an illness after it has developed but not always.

Antibiotic prophylaxis

This is the administration of antibiotics used to prevent the infection rather than treating an existing one. It is most commonly used with patients that are a higher risk of infection due to some health condition or has a suppressed immune system. Sometimes this type of prophylaxis is used to prevent infections when exposure to an infection is likely. Antibiotic prophylaxis is common in patients with organ transplant patients and ones with certain heart conditions. It can also be given before receiving dental care that involves disrupting the gum tissue, to patients who have suffered a wound, or undergone surgery. Many medical providers try to be cautious when giving antibiotic prophylaxis because each time one is given it can lessen the effectiveness.

Sometimes antibiotic prophylaxis is given to avoid infection such as with small children who attend school or live with an infected child and are at risk of acquiring the infection. Depending on the surgical procedure it can be administered as part of the postoperative care routine. Most of these antibiotics are broad-spectrum antibiotic, which are made to work against a broad spectrum of bacteria. This includes penicillin and derivatives of penicillin. For those allergic to penicillin there is cephalosporins.

Antimicrobial prophylaxis

This is a medical technique that is used to prevent infections in certain situations. It is primarily restricted to ones who may contact diseases while on vacation or patients who are undergoing some surgeries. Antibiotics are commonly used in this type of prophylaxis but also under this type are other medications that focus on other microbes like parasites or fungi. If someone’s natural defenses against infections are damaged and they have an increased risk of serious infection a surgeon may put them on an antimicrobial prophylaxis regime before, during, and after their surgery.

Dental antibiotic prophylaxis

These are administered to patients who are in a high-risk category to develop an infection because of certain dental procedures. It is mainly used to prevent infections that can affect a ‘patient’s heart. One example is a medical condition called infective endocarditis. This is an infection that can happen to the valves of their heart or on the outside of their heart. What dosage is used for this type of prophylaxis will depend on which type of antibiotic is used. Generally the standard dosage is two grams of amoxicillin orally to adults but if they cannot take oral medications they would get two grams intravenously. For children it is based on weight and for every two point two pounds of weight they would be given fifty milligrams of ampicillin or amoxicillin. If they are allergic to penicillin they would be given a different antibiotic. There are some dangers with dental antibiotic prophylaxis such as potentially severe breathing problems and rash.

DVT prophylaxis

DVT is the abbreviation for deep vein thrombosis and by giving this type of prophylaxis it is to prevent the development of this condition in patients who are risk for it. If a person has DVT a blood clot forms in the deep veins of their leg or arm, blocking the blood flow, which can lead to complications. An example of a serious complication is if a blood clot breaks loose and travels to their lungs blocking their airway, and can be fatal because the onset is so fast they do not get a chance to seek treatment. Ones that might need this are those surgical patients who need surgery that lasts longer than two hours, people over the age of forty, severe physical trauma, people with a history of surgery, or cancer patients having surgery. DVT prophylaxis can be mechanical such as compression stockings, or pharmacological such as medication to prevent clotting.

Endocarditis prophylaxis

This type is used to prevent bacterial infections of your heart prior to certain types of exposure that could elevate the risk. This would mean that the physician would administer antibiotics prior to any treatment that would pose a risk for bacteria to enter your bloodstream and make its way to your heart where it would grow and obstruct your heart function. The procedure is to give the antibiotic in a single large dose about sixty minutes before the procedure takes place. How much would depend on the age, size, and the individual. The circumstances when a person would receive these antibiotics are usually during dental procedures but can be used for other situations such as medical procedures on the gastrointestinal tract.

HIV prophylaxis

With HIV prophylaxis it is used as a treatment aimed at preventing the transmission of HIV, of which there are two types.

• Pre-exposure prophylaxis – this type of HIV prophylaxis is still in its infancy as at this time there is not enough evidence gathered for a definite conclusion about the efficacy of this type.
• Post-exposure prophylaxis – this type of HIV prophylaxis has a better and longer established track record. With this one it involves being given a twenty-eight day course of antiretrovirals if you have come into contact with the bodily fluids of a person with HIV. It is more commonly used when a health care worker, like a doctor or nurse, has been stuck with a needle that contains the blood of a person who is HIV-positive. It is also given to infants whose mother’s have tested HIV-positive. Although rare, it has been used for rape victims as a “morning afterward” or for those who have had consensual sex with an injection drug user or with a person who has or is likely to develop HIV. It is most effective if it is started within thirty-six to seventy-two hours. In health care workers who take the full course of twenty-eight days decreases their odds by seventy-nine percent of being infected by HIV.

Using HIV prophylaxis is not an easy fix to HIV exposure because these medications are expensive and are often prohibitively so if you do not have insurance. There are also severe side effects such as vomiting, diarrhea, fatigue, nausea, and headache that some experience. Sometimes they are so severe that some are not able to complete the entire twenty-eight day course. If a person has repeated usage of these antiretrovirals it could increase their risk of acquiring a treatment-resistive form of HIV. The best HIV prophylaxis possible is being treated with the medication after exposure to HIV.

Malaria prophylaxis

This is used as a preventive treatment of malaria. When given medications it is best weigh the risk of infection against the side effects and risks that are associated with the medications. There are many medications that can be used to prevent malaria infections. When you are considering traveling where you might contact malaria you need to think about how much you are willing to spend on malaria prophylaxis as weekly medications are more expensive than daily medications. If you do not want to take any of the medications you can always use bed nets but these are no guarantee you will not get the malaria infection. The different malaria prophylaxis available targets certain areas of the world. For example, the specific type of malaria that is common in Southeast Asia is the P. vivax, and the medication to use for that type of malaria prevention would be primaquine. What is used should also be based on how often you are willing to take the medication and the length of your trip. Some are to be taken daily while others are taken weekly. Make sure that you do your research well in advance of your trip if you are planning on using malaria prophylaxis.