From the Guidelines
In India, the treatment for dog bites should follow a comprehensive approach focusing on immediate wound care, rabies prevention, and antibiotic prophylaxis, with amoxicillin-clavulanate being a recommended antibiotic option, as per the guidelines from the Infectious Diseases Society of America 1.
Immediate Wound Care
Immediate wound care is crucial in preventing infection and promoting healing. This includes:
- Washing the wound thoroughly with soap and running water for at least 15 minutes
- Applying an antiseptic like povidone-iodine
- Seeking medical attention promptly for wound assessment and possible suturing
Rabies Prevention
Rabies post-exposure prophylaxis is essential and includes:
- Rabies immunoglobulin (RIG) infiltrated around the wound at 20 IU/kg body weight for category III bites
- Rabies vaccine administered as a 5-dose regimen on days 0,3,7,14, and 28 in the deltoid muscle
- For previously vaccinated individuals, only two booster doses on days 0 and 3 are needed
Antibiotic Prophylaxis
Antibiotics like amoxicillin-clavulanate (500-875mg twice daily for 3-5 days) may be prescribed to prevent bacterial infection, as recommended by the Infectious Diseases Society of America 1. The choice of antibiotic should be based on the type of bite, size and location of the wound, and time interval since the bite.
Tetanus Prophylaxis
Tetanus prophylaxis is also important, with a tetanus toxoid injection given if not vaccinated within 5 years 1.
Key Considerations
- Wound cleansing is crucial in rabies prevention, and thorough wound cleansing alone without other postexposure prophylaxis can markedly reduce the likelihood of rabies 1
- Decisions regarding the use of antibiotic prophylaxis and primary wound closure should be individualized based on the exposing animal species, size and location of the wound, and time interval since the bite 1
From the Research
Treatment Guidelines for Canine Bites in India
- The treatment guidelines for canine bites in India involve a three-pronged approach including proper wound management, judicious use of antirabies serum, and modern tissue culture vaccines 2.
- The World Health Organization (WHO) recommends the use of intradermal route of inoculation of Tissue Culture Vaccine, which makes the treatment very economical, but this route is not yet approved by the Drug Controller, Government of India (DCGI) 2.
- There are no uniform guidelines for the management of animal bite cases in India, highlighting the need for standardized protocols 2.
Wound Management and Post-Exposure Prophylaxis
- Proper wound management, including washing the wound with soap and water, is essential in preventing rabies transmission 3, 4.
- However, many people in India are not aware of the importance of proper wound management, and some may use indigenous products or seek treatment from occult medicine practitioners 3.
- Post-exposure prophylaxis (PEP) is critical in preventing rabies, but many people in India are not aware of the number of injections needed for treatment, and some may not complete the full course of treatment due to various reasons such as fear of painful injections, expensive treatment, or long course requiring daily visits to anti-rabies clinics 3, 4.
Epidemiology of Animal Bites and Rabies in India
- Dog bites are responsible for the majority of animal bites requiring antirabies treatment in India, with stray dogs being the primary source of bites 2, 4.
- The epidemiology of animal bites and rabies in India is influenced by various factors, including the availability of safe and effective anti-rabies immunobiologicals, the strength of information, education, and communication (IEC) programs, and the awareness of the general community and service providers about the disease 4.
- A study conducted in rural Patna found a significant knowledge gap regarding dog bite management, highlighting the need for structured educational campaigns and community-level interventions to improve rabies prevention 5.
Need for a One Health Approach
- The control of rabies in India requires a holistic approach that encompasses education, provision of post-exposure prophylaxis (PEP) and canine rabies vaccines for dogs, promotion of responsible dog ownership, and intersectoral collaboration 6.
- Strengthening communication channels through effective data exchange and encouraging synergy among healthcare, veterinary, and public health sectors is indispensable to maximize the impact of rabies prevention and control interventions 6.