What is the treatment for rabies exposure?

Treatment for Rabies Exposure

Immediate post-exposure prophylaxis is essential for rabies exposure and consists of wound cleansing, rabies immune globulin, and vaccination to prevent this nearly 100% fatal disease. 1, 2

Immediate Wound Treatment

• Thoroughly wash and flush all bite wounds and scratches with soap and water for approximately 15 minutes 2, 3
• Apply a virucidal agent such as povidone-iodine solution to the wound if available 2, 1
• Evaluate the need for tetanus prophylaxis and measures to control bacterial infection 1, 4
• Avoid suturing when possible to prevent further introduction of the virus 1

Post-Exposure Prophylaxis Components

For previously unvaccinated individuals:

1. Passive Immunization (Rabies Immune Globulin)

• Administer human rabies immune globulin (HRIG) at 20 IU/kg body weight 2, 5
• Infiltrate the full dose around and into the wound(s) if anatomically feasible 2, 1
• Inject any remaining volume intramuscularly at a site distant from vaccine administration 2, 5
• HRIG is administered only once, at the beginning of post-exposure prophylaxis 1, 5

2. Active Immunization (Rabies Vaccine)

• Administer 4 doses of rabies vaccine on days 0,3,7, and 14 2, 4
• Give vaccine intramuscularly in the deltoid area for adults 2, 4
• For children, the anterolateral thigh is an acceptable alternative site 2, 4
• Never administer the vaccine in the gluteal area as it results in lower antibody titers 2, 4

Special Considerations

For Previously Vaccinated Individuals

• Administer only 2 doses of vaccine (on days 0 and 3) 2, 1
• HRIG is not necessary for previously vaccinated individuals 1, 4

Animal Management

• A healthy domestic dog, cat, or ferret that bites a person may be confined and observed for 10 days 1, 5
• If signs of rabies develop in the animal during observation, immediately euthanize it and test for rabies 1, 5
• For wild animals (especially bats, skunks, raccoons, foxes), consider them potentially rabid unless proven negative by laboratory testing 5

Common Pitfalls to Avoid

• Delaying post-exposure prophylaxis - treatment should begin as soon as possible after exposure 1, 3
• Failing to infiltrate HRIG around all wounds 2, 5
• Administering vaccine in the gluteal area instead of the deltoid 2, 4
• Discontinuing post-exposure prophylaxis prematurely - complete the full course unless the animal tests negative for rabies 4, 5

Decision Algorithm for Post-Exposure Prophylaxis

1. Assess exposure type (bite vs. non-bite) and animal species involved 1, 5
2. For domestic animals (dogs, cats, ferrets):
   • If healthy and available for 10-day observation: Begin prophylaxis only if animal develops signs of rabies 1, 5
   • If rabid, suspected rabid, or unknown status: Begin full prophylaxis immediately 1, 5
3. For wild animals (bats, skunks, foxes, raccoons):
   • Consider rabid unless proven negative by laboratory testing 5
   • Begin full prophylaxis immediately 5

Remember that rabies is nearly 100% fatal once clinical symptoms appear, making proper post-exposure prophylaxis critical for survival 1, 6. The combination of wound cleansing, HRIG, and vaccination is nearly 100% effective when administered promptly and correctly 6.

Human Medical AI - GPT