Recommended Dose of Rabies Immunoglobulin (Rabishield)
The recommended dose of Rabishield (Rabies Immunoglobulin) is 20 IU/kg body weight, applicable to all age groups including children. 1, 2, 3
Administration Guidelines
- Rabies immunoglobulin should be administered only once at the beginning of post-exposure prophylaxis to provide immediate passive immunity until the patient develops antibodies in response to the vaccine 1, 2
- If not given when vaccination was initiated (day 0), rabies immunoglobulin can still be administered through the seventh day after the first vaccine dose 1, 2
- Beyond the seventh day, rabies immunoglobulin is not indicated as an antibody response to the vaccine is presumed to have occurred 1, 2
Administration Technique
- If anatomically feasible, the full dose of rabies immunoglobulin should be thoroughly infiltrated in and around the wound(s) 1, 2, 3
- Any remaining volume should be injected intramuscularly at a site distant from vaccine administration (typically the deltoid or lateral thigh) 1, 3
- The gluteal area should not be used as an injection site due to risk of injury to the sciatic nerve 3
- This infiltration recommendation is based on reports of rare failures of post-exposure prophylaxis when less than the full amount was infiltrated at exposure sites 1, 2
Important Precautions
- Rabies immunoglobulin should never be administered in the same syringe or at the same anatomical site as the first vaccine dose 1, 2, 3
- Do not exceed the recommended dose (20 IU/kg) as rabies immunoglobulin can partially suppress active production of antibody 1, 2
- The combination of rabies immunoglobulin and vaccine is recommended for both bite and non-bite exposures in previously unvaccinated persons 1, 2
Clinical Considerations
- Studies have shown that the 20 IU/kg dose provides adequate passive immunity with detectable antibody levels within 24 hours of administration 3, 4
- Despite clear guidelines, a study found that while adherence to proper dosing (98%) and timing (100%) was high, only 56% of eligible patients received proper wound infiltration as recommended 5
- For previously vaccinated individuals (those who have received complete pre-exposure or post-exposure prophylaxis with cell culture vaccines), rabies immunoglobulin should NOT be administered 1, 2, 3
- Immunocompromised patients should receive the full 5-dose vaccine schedule along with rabies immunoglobulin at 20 IU/kg 1, 2
Common Pitfalls to Avoid
- Failing to infiltrate wounds properly with rabies immunoglobulin - this is critical for effectiveness 1, 2, 5
- Administering rabies immunoglobulin to previously vaccinated individuals 1, 3
- Using less than the recommended dose of 20 IU/kg 1, 3
- Delaying administration beyond 7 days after the first vaccine dose 1, 2
- Administering rabies immunoglobulin in the gluteal area 3