How soon after exposure should a patient receive rabies immunoglobulin (RIG)?

Rabies Immunoglobulin Administration Timing

Rabies immunoglobulin (RIG) should be administered as soon as possible after exposure, ideally within 24 hours, but can be given up to 7 days after the first dose of rabies vaccine if not initially administered. 1

Administration Timeline and Protocol

• Day 0 (as soon as possible after exposure):

  • Administer RIG at 20 IU/kg body weight
  • Begin first dose of rabies vaccine
  • Thoroughly clean wound with soap and water for at least 15 minutes

• Up to Day 7:

  • If RIG was not given when vaccination began, it can still be administered up to and including day 7 of the post-exposure prophylaxis series 2
  • Beyond the seventh day, RIG is not indicated because an antibody response to the vaccine is presumed to have occurred 2

Proper Administration Technique

• If anatomically feasible, the full dose of RIG should be thoroughly infiltrated in the area around and into the wounds 2, 1
• Any remaining volume should be injected intramuscularly at a site distant from vaccine administration 2
• RIG should never be administered in the same syringe or anatomical site as the first vaccine dose 2

Dosing Considerations

• The recommended dose is 20 IU/kg body weight for all age groups, including children 2, 1
• Do not exceed the recommended dose as RIG can partially suppress active production of antibody 2
• Studies show that 98% of patients receive doses within 10% of the recommended 20 IU/kg 3

Common Pitfalls to Avoid

1. Improper wound infiltration: Only 56% of eligible patients receive RIG infiltration at wound sites as recommended by guidelines 3. Ensure thorough infiltration of all wounds when anatomically feasible.

2. Delayed administration: While RIG should ideally be given immediately, remember it can still be beneficial if administered within 7 days of starting vaccination.

3. Incorrect anatomical site for vaccine: For adults, rabies vaccine should always be administered in the deltoid area, never in the gluteal area which results in lower neutralizing antibody titers 2

4. Administering RIG to previously vaccinated individuals: RIG is not recommended for persons who have previously received complete rabies vaccination regimens 2, 1

Special Populations

• Immunocompromised patients: May require serologic testing after vaccination to confirm adequate antibody response 1
• Pregnant women: Pregnancy is not a contraindication to post-exposure prophylaxis 1

Remember that proper wound cleansing with soap and water is a critical first step in rabies prevention, as thorough wound cleansing alone can markedly reduce the likelihood of rabies 2.