Which medications in the drug class Passive Immunizing Agents are used in the treatment of Rabies?

Updated: Jun 21, 2019
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print

Passive Immunizing Agents

Rabies immunoglobulin is recommended as part of the rabies postexposure regimen for persons not previously immunized against rabies. Vaccine and antiserum should never be mixed or injected in the same limb.

In the United States, passive immunization consists of administration of HRIG pooled from the sera of immunized human donors. In developing countries, equine rabies immunoglobulin (ERIG) is sometimes used but has a higher incidence of adverse effects. ERIG is no longer produced by large pharmaceutical companies. When produced by smaller pharmaceutical firms, its quality cannot be assured. New-generation purified ERIG preparations are under investigation.

Human rabies virus–specific monoclonal antibody preparations are in development, theoretically to decrease the possibility of anaphylaxis. [50, 51, 52]

Because of cost, ERIG and HRIG are not readily available throughout much of the developing world, areas in which rabies is more common than in the United States. If HRIG is available only after more than a week after vaccination has started, then it is probably unnecessary, because an active antibody response has already begun.

Rabies immune globulin, human (RIG) (HyperRAB S/D, KedRab, Imogam Rabies-HT)

HRIG has been licensed since 1975, and unlike its predecessor, ERIG, it is not associated with significant adverse reactions, anaphylaxis, or serum sickness. Purified ERIG is still used in some developing nations because of cost or availability and is associated with an adverse effect rate of 0.8-6%, which usually involves minor reactions. HRIG is not associated with transmission of viral hepatitis or HIV. Experimentally, infiltration of HRIG at the site of exposure is more protective than IM administration. The current recommendation is that the entire dose be infiltrated, if possible, in and around the site, with any remaining solution administered IM in the gluteus.

Heat-treated and cold alcohol–fractionated immunoglobulin is derived from pooled human plasma from individuals immunized with human diploid cell rabies vaccine.

A stabilized, ready-to-use solution for injection (KedRab) is also available.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!