What is the immediate management for an animal bite in the Philippines?

Immediate Management of Animal Bites in the Philippines

When bitten by an animal in the Philippines, immediately wash the wound thoroughly with soap and water for at least 15 minutes, then seek medical attention urgently for rabies postexposure prophylaxis (PEP) consisting of both rabies immune globulin and rabies vaccine, which should be initiated within 24 hours of exposure. 1, 2, 3

Critical First Steps: Wound Care

Immediate wound management is the single most effective measure for preventing rabies and must be performed before any other intervention. 1

• Wash all bite wounds and scratches thoroughly with soap and water for 15 minutes - this simple measure dramatically reduces rabies transmission risk 1, 3
• Gently irrigate wounds with water or dilute povidone-iodine solution without damaging tissues 1
• Avoid suturing wounds when possible to allow drainage and reduce infection risk 1
• Administer tetanus prophylaxis based on vaccination history 1, 2
• Consider antibiotic prophylaxis, particularly for hand bites (which have higher infection rates) and human bites 1, 4

Rabies Postexposure Prophylaxis Protocol

Both rabies immune globulin (RIG) and rabies vaccine must be administered simultaneously at the first medical visit, regardless of time elapsed since exposure. 1, 2

For Previously Unvaccinated Patients:

• Administer rabies immune globulin (RIG) immediately - infiltrate as much as possible deep into and around all wounds, with any remaining volume given intramuscularly at a site distant from vaccine administration 1, 2
• Start rabies vaccine series as soon as possible, ideally within 24 hours of exposure 1, 2
• Use a 5-dose vaccine regimen over 28 days (days 0,3,7,14,28) 1
• RIG is given only once at the beginning of prophylaxis to provide immediate antibody coverage until the body produces its own antibodies 1, 2
• RIG can be administered up to and including day 7 after the first vaccine dose, but never give RIG after day 7 as it may interfere with active immunity 1, 2

For Previously Vaccinated Patients:

• Administer vaccine only (no RIG needed) if the patient has documented prior complete rabies vaccination 1, 2
• Give 2 doses of vaccine on days 0 and 3 1

Animal-Specific Management Decisions

Dogs, Cats, and Ferrets:

• If the animal is healthy and available for observation: Confine and observe the animal daily for 10 days without administering rabies vaccine during this period 5, 2
• Do not delay starting PEP while waiting for the 10-day observation period - begin immediately and discontinue only if the animal remains healthy for 10 days 2
• Any illness in the confined animal must be reported immediately to local health authorities 5
• If the animal is stray, unwanted, or unavailable: Initiate full PEP immediately with both RIG and vaccine 2

Wild Animals (Bats, Skunks, Foxes, Raccoons, Coyotes):

• Regard all wild carnivorous mammals and bats as rabid unless proven negative by laboratory testing 2
• Initiate immediate prophylaxis with both RIG and vaccine without waiting for testing results 1, 2
• The animal should be euthanized and tested as soon as possible 2

Rodents and Rabbits:

• Bites from squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, rabbits, and hares almost never require rabies PEP in most geographical areas 2
• Consult local public health officials for specific regional recommendations 2

Critical Timing Considerations

Rabies PEP is a medical urgency, not an emergency, but decisions must not be delayed. 1

• Administer PEP regardless of delay since exposure, provided the patient shows no clinical signs of rabies 1
• Incubation periods exceeding 1 year have been documented, emphasizing the importance of prophylaxis even for delayed presentations 1
• Once clinical rabies develops, PEP is consistently ineffective - rabies is virtually 100% fatal after symptom onset 1
• PEP can be discontinued if laboratory testing confirms the animal was not rabid 1, 2

Evidence from the Philippines

A large case series from the Research Institute for Tropical Medicine (RITM) in the Philippines involving 7,660 patients demonstrated excellent outcomes with the recommended PEP protocol using purified equine rabies immunoglobulin. 6

• Of 151 patients with laboratory-confirmed rabies exposure who received proper PEP, 143 survived (94.7% survival rate) 6
• The two PEP failures involved severe Category III exposures with delayed or incomplete treatment, highlighting the critical importance of immediate and complete prophylaxis 6
• This confirms that the recommended treatment schedule is both well-tolerated and highly effective when properly administered 6

Common Pitfalls to Avoid

• Never delay prophylaxis waiting for animal testing results if the animal is unavailable or high-risk 1, 2
• Do not exceed the recommended RIG dosage as excess can suppress vaccine response 1
• Do not administer RIG after day 7 of the vaccine series 1, 2
• Do not withhold prophylaxis based on time elapsed since exposure, unless clinical rabies is present 1
• Do not skip wound washing - this is perhaps the most effective single measure for preventing rabies 1, 2
• Do not suture wounds unnecessarily - allow drainage when possible 1
• For hand bites specifically, prophylactic antibiotics significantly reduce infection risk (NNT = 4) and should be strongly considered 4

Human bites have higher infection rates than dog or cat bites and benefit more from antibiotic prophylaxis. 4