Treatment for Category 2 Animal Bite
For a Category 2 animal bite (defined by WHO as nibbling of uncovered skin or minor scratches/abrasions without bleeding), immediate thorough wound washing with soap and water is essential, followed by rabies vaccination but NOT rabies immunoglobulin. 1
Immediate Wound Management
Perform immediate and thorough wound cleansing with soap and water or sterile normal saline, as this is the single most important intervention for preventing rabies and bacterial infection. 1
Use copious irrigation with water or dilute water povidone-iodine solution to mechanically remove debris and reduce bacterial load. 1
Avoid aggressive debridement or tissue damage during cleansing—gentle irrigation is sufficient for Category 2 exposures. 1
Do not suture Category 2 wounds; these minor abrasions should be left open to heal by secondary intention. 1
Rabies Prophylaxis Protocol
Category 2 exposures require rabies vaccination ONLY—rabies immunoglobulin (HRIG) is NOT indicated. 1
Administer 5 doses of rabies vaccine (HDCV or PCECV) intramuscularly on days 0,3,7,14, and 28. 1
Give vaccine in the deltoid area for adults; the anterolateral thigh is acceptable for children. 1
Never administer rabies vaccine in the gluteal area, as this results in lower neutralizing antibody titers. 1
Begin vaccination as soon as possible after exposure—this is a medical urgency, not an emergency, but should not be delayed. 1
Exception for Previously Vaccinated Persons
If the patient has ever received a complete pre-exposure or post-exposure rabies vaccination series with cell culture vaccine, give only 2 doses of vaccine on days 0 and 3—no immunoglobulin is needed. 1
Previously vaccinated persons with documented rabies antibody titers require only vaccine, not HRIG. 1
Tetanus Prophylaxis
Administer tetanus toxoid 0.5 mL intramuscularly if vaccination status is outdated or unknown. 1
For clean minor wounds, give a booster if more than 10 years since last dose; for contaminated wounds, give a booster if more than 5 years since last dose. 2
Antibiotic Considerations
Antibiotic prophylaxis is generally NOT required for Category 2 animal bites (minor scratches without bleeding) unless signs of infection develop. 3
If infection develops, use amoxicillin-clavulanate as first-line therapy, providing coverage for Pasteurella multocida and other typical wound pathogens. 2, 3
For penicillin-allergic patients, alternatives include doxycycline or a fluoroquinolone plus metronidazole. 2
Critical Pitfalls to Avoid
Do not confuse Category 2 with Category 3 exposures: Category 3 (transdermal bites or scratches WITH bleeding, or mucous membrane contamination) requires BOTH vaccine AND immunoglobulin. 1
Do not delay rabies vaccination while waiting for animal observation results—begin immediately and discontinue only if the animal remains healthy after 10 days of observation (for dogs, cats, ferrets in non-endemic areas). 1
Do not use the gluteal area for vaccine administration—this is a documented cause of vaccine failure. 1
The distinction between Category 2 and Category 3 is critical: Category 2 has no bleeding, while Category 3 involves bleeding or mucous membrane exposure, which dramatically changes the treatment protocol. 1