What is the initial care of animal bites with possible exposure to rabies?

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

As previously stated, washing and wound debridement at the time of a bite is essential, along with careful cleaning of the wound for longer than 10 minutes. Generally, leave wounds to heal by secondary intention. [27, 28] Antibiotic prophylaxis should be considered. [28, 38]

Administer HRIG to any person not previously vaccinated against rabies, at a dose of 20 IU/kg (for adults and children). Apply as much of the dose as possible at the injury site and the remainder as a deep IM injection in the gluteal area. HRIG may be administered as long as 7 days after the first dose of vaccine if it is not immediately available when the patient presents for evaluation. [13, 27]

Equine rabies immunoglobulin may be available in other countries. Minimal adverse effects occur if it is in the purified form. If unpurified, however it may cause serum sickness and anaphylaxis.


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