Orris

Rabies treatment

Reading File
Reading File
Finding Sources
Searching PubMed

rabies AND postexposure prophylaxis

Searching the Web

WHO rabies post-exposure prophylaxis wound washing vaccine immunoglobulin guidance

If you have been bitten, scratched, or had saliva from a bat or possibly rabid animal contact your eyes, mouth, or broken skin: seek urgent medical care today. Rabies prevention must start before symptoms appear.

Immediate first aid

  1. Wash and flush the wound continuously for 15 minutes with lots of soap and running water.
  2. Apply iodine or another antiseptic if available.
  3. Do not tightly bandage the wound. Get assessed for tetanus and possible antibiotics.

Post-exposure prophylaxis (PEP)

A clinician determines the course based on the animal, location, and type of exposure. PEP generally includes:
  • Rabies vaccine for bites, scratches that break skin, or saliva exposure to mucosa/broken skin.
  • Rabies immunoglobulin (RIG) for severe exposures in someone not previously vaccinated, especially any transdermal bite/scratch, saliva on broken skin/mucosa, or bat exposure. It should be infiltrated into and around all wounds as much as anatomically possible, with the remainder injected elsewhere.
  • Vaccine schedules vary by country and whether intradermal or intramuscular vaccine is used. WHO recommends prompt wound care plus vaccine for category II/III exposures, and RIG in addition for category III exposure. See WHO PEP recommendations.
If you previously completed rabies vaccination or PEP, you usually need only vaccine booster doses on days 0 and 3, not RIG.

If symptoms have started

Once clinical rabies begins, there is no reliably effective curative treatment and it is almost always fatal. Hospital care is supportive and specialist-led. This is why exposure treatment should not be delayed. Jawetz, Melnick & Adelberg's Medical Microbiology, “Treatment and Control.”
Do not wait to observe symptoms or wait for the animal to become ill before seeking medical advice. In some settings, a healthy dog/cat may be observed for 10 days, but the decision to delay, start, or stop PEP must be made by local public-health or emergency clinicians.
This is a shared conversation. Sign in to Orris to start your own chat.