Paediatric

Post-exposure Prophylaxis for Paediatrics

  • Any child potentially exposed to HIV either through a needle exposure or sexual exposure or other should be fully assessed by a Paediatric Infectious Diseases consultant or registrar who will risk assess the need for prophylactic medication.
  • Due to variability of regimens there are no starter packs available for paediatrics but most supplies can be accessed from the John Radcliffe Pharmacy. Out of hours the on-call pharmacist can be contacted for supplies.
  • If indicated, post exposure prophylaxis should be started without delay and always within 72 hours of exposure.
  • It is recommended that initial supply is limited to 5-7 days with the patient reviewed within this period and then further supplies can be issued. A total course of 28 days should be completed.
  • Liquid and chewable products may not always be available in all strengths/concentrations. See 'Formulation Considerations' section below for advice on crushing tablets. 

In the following situations an alternative regime may be required and this should always be in consultation with Paediatric Infectious Diseases team via OUH switchboard:

  • Infection source is known or believed to have a resistant virus
  • One or more of the first line drugs are not appropriate (e.g. renal impairment)
  • If first line formulations are not available

See following table for the first line regimen. If other HIV agents are recommended by HIV specialist dosing information can be found in Post-Exposure Prophylaxis (PEP) Guidelines for children and adolescents exposed to blood-borne viruses (chiva.org.uk)

Preferred

Regimens should always consist of three active antiretroviral drugs given in combination and dosed according to the patient’s weight/age.

Age/Weight First line regimen Doses

40kg and over

AND

12 years and over

 

 

 

 

 

 

 

 

 

 

 

Tenofovir disoproxil fumarate/emtricitabine

AND

Raltegravir

Tenofovir disoproxil fumarate is not recommended in renal impairment and alternatives should be considered - discuss with Paediatric Infectious Diseases team

Able to swallow tablets:

Tenofovir disoproxil fumarate 245mg/emtricitabine 200mg tablet (1 tablet) OD       

AND

Raltegravir tablet 1.2g (2x600mg) OD

 

Unable to swallow tablet to crush and disperse:

Tenofovir disoproxil fumarate 245mg/emtricitabine 200mg 1 tablet OD

AND

Raltegravir tablet 400mg BD

 

If unable to tolerate crushed tablets: Discuss with HIV or Antimicrobial pharmacists

6 years and over

AND

25kg to 40kg 

Dolutegravir

AND

Lamivudine

AND

Zidovudine

Dolutegravir tablet 50mg OD

AND

Lamivudine tablet 300mg OD

AND

Zidovudine capsule (use zidovudine liquid if capsules unavailable – see dosing below)

Zidovudine capsules:

25-27kg: 200mg BD 

28-29kg: 250mg BD

30kg and above: 250mg-300mg BD

Zidovudine liquid: 9mg/kg (Max dose 300mg) BD

Under 6 years

AND

under 25kg

Dolutegravir

AND

Lamivudine

AND

Zidovudine

If OUH does not have the formulation of dolutegravir and PEPSE is needed immediately then use the Lamivudine and Zidovudine alone until dolutegravir is available.

Dolutegravir dispersible tablet (dosing as table below)

Weight

Dose

20kg or more

30mg OD

14 – 19kg

25mg OD

10-13 kg

20mg OD

6-9 kg

15mg OD

3-5 kg

5mg OD

AND

Lamivudine Liquid: 5 mg/kg BD or 10mg/kg OD (Max dose 300mg/day)

AND

Zidovudine liquid

9-30kg: 9mg/kg (Max dose 300mg) BD 

4-8kg: 12mg/kg (Max dose 300mg) BD 

If Dolutegravir dispersible tablet and/or lamivudine liquid not available:

Dolutegravir and lamivudine standard tablet can be crushed and dispersed. See below for dosing.

Dolutegravir tablet:

20kg and over: 50mg OD

Lamivudine tablet:

20-24kg: 75mg (half a 150mg tablet) AM and 150mg PM

OR 225mg (one and a half 150mg tablet) OD

14-19kg: 75mg (half a 150mg tablet) BD OR 150mg OD

Less than 3kg 

OR

less than 4 weeks

 Consult Paediatric Infectious Diseases HIV specialist  Contact Paediatric Infectious Diseases team via switch board

Formulation Considerations

  • Raltegravir formulations are NOT bioequivalent and therefore not interchangeable.
  • Dolutegravir and lamivudine 150mg standard tablet can be crushed and dispersed.
  • Tenofovir disoproxil fumarate/emtricitabine can be crushed and dispersed in water or orange juice (licensed). Preparation tastes bitter. 
  • Raltegravir can be crushed and dispersed in water (unlicensed). Preparation tastes bitter.

Guidance

Dosing for other HIV agents, if recommended by HIV specialist, see Post-Exposure Prophylaxis (PEP) Guidelines for children and adolescents exposed to blood-borne viruses (chiva.org.uk)

Advice to be provided

  • Take the first dose immediately and complete the course.
  • Ensure patient and/or parent/guardian know how to administer the medication, what dose to take, dosing frequency and duration.
  • Check drug history and consider drug interactions. Antacids (e.g. Gaviscon®), calcium or iron supplements should not be taken at same time as raltegravir – avoid these 4 hours before and after a dose of raltegravir.  
  • Arrangements for follow up and to obtain further supplies of medication.
  • Provide appropriate HIV Pharmacy Association patient leaflet. Note that these are adult leaflets.

Editorial Information

Last reviewed: 01 Sept 2023

Author(s): AMST.

Approved By: MMTC