I sustained a laceration while preparing a rabbit; what is the appropriate wound cleaning, tetanus prophylaxis, antibiotic therapy, and need for rabies post‑exposure prophylaxis?

Management of Laceration from Rabbit Preparation

For a laceration sustained while preparing a rabbit, immediately irrigate the wound thoroughly with soap and water followed by povidone-iodine solution, administer tetanus prophylaxis if not current within 10 years (5 years for contaminated wounds), consider prophylactic antibiotics (amoxicillin-clavulanate) for moderate-to-severe wounds or high-risk locations, and rabies post-exposure prophylaxis is NOT indicated as rabbits are not significant rabies vectors in the United States. 1, 2

Immediate Wound Management

Wound Cleansing

• Irrigate copiously with soap and water for at least 15 minutes immediately – this is the single most critical intervention that markedly reduces both bacterial infection and rabies transmission risk in animal studies 1
• Follow with dilute povidone-iodine solution (1-10%) irrigation, taking care not to damage tissues with excessive scrubbing 1, 3
• Avoid primary closure unless the wound is on the face for cosmetic reasons; otherwise, approximate edges with Steri-Strips or leave open 4, 5
• Never suture hand wounds as they have significantly higher infection rates when closed 4

Assessment for Serious Injury

• Examine carefully for nerve or tendon laceration, particularly in hand wounds near joints 1, 5
• Deep tissue involvement or suspected bone/synovial penetration requires specialist evaluation and possible hospitalization with IV antibiotics 6

Tetanus Prophylaxis

• Administer tetanus toxoid (preferably Tdap if not previously given) if more than 10 years since last dose 4
• For contaminated wounds (which a rabbit preparation injury likely is), give tetanus booster if more than 5 years since last dose 4, 6
• Dose is 0.5 mL intramuscularly in the deltoid 6

Antibiotic Therapy

Indications for Prophylactic Antibiotics (3-5 days)

• Moderate to severe lacerations, especially on hand or face 4
• Immunocompromised, asplenic, or advanced liver disease patients 4
• Pre-existing or resulting edema in the affected area 4
• Wounds that will be closed (facial wounds) 5

Antibiotic Selection

• First-line: Amoxicillin-clavulanate 875/125 mg twice daily – provides coverage for both aerobic and anaerobic bacteria commonly found in animal bite wounds 4, 5
• For penicillin allergy: Doxycycline 100 mg twice daily (excellent activity against Pasteurella species) 5
• Avoid first-generation cephalosporins, macrolides, or clindamycin alone as they provide inadequate coverage 5
• Standard treatment duration is 7-10 days if infection develops 6

Rabies Post-Exposure Prophylaxis

Rabies prophylaxis is NOT indicated for rabbit exposures in the United States. 2

Rationale

• Rabbits and other lagomorphs (hares) are rarely found to be infected with rabies and have not been known to cause human rabies in the United States 2
• Small rodents and lagomorphs almost never require antirabies post-exposure prophylaxis 2
• Consult local or state health department if any uncertainty exists, but routine prophylaxis is not warranted 1, 2

If Prophylaxis Were Indicated (for reference only)

• Previously unvaccinated persons would receive both human rabies immune globulin (HRIG) 20 IU/kg body weight infiltrated around the wound plus rabies vaccine series (5 doses over 28 days) 1
• HRIG can be given up to day 7 after first vaccine dose 1

Follow-Up Care

• Reassess within 24 hours (phone or office visit) for signs of infection: increasing pain, redness, swelling, purulent discharge, lymphadenitis, or systemic symptoms 6
• Elevate the injured extremity to reduce swelling 5
• Extended antibiotic therapy may be necessary if infection develops despite initial prophylaxis 5

Common Pitfalls to Avoid

• Do not delay wound irrigation – immediate washing is the most critical intervention and should not wait for medical evaluation 1, 6
• Do not use inadequate irrigation volume or duration – copious irrigation for at least 15 minutes is essential 6
• Do not close hand wounds or wounds with high infection risk – primary closure significantly increases infection rates except for facial wounds 4, 5
• Do not prescribe inadequate antibiotic coverage – single-agent therapy with cephalosporins or macrolides fails to cover the polymicrobial nature of animal wounds 5
• Do not assume all animal exposures require rabies prophylaxis – rabbits are not rabies vectors in the US, and unnecessary prophylaxis exposes patients to risk without benefit 2