First-aid treatment: Immediate care of bite wounds and scratches potentially contaminated with rabies virus is essential, regardless of the time elapsed since exposure. The wound should be thoroughly washed and flushed with soap, water, detergent, or other agents proven to inactivate the virus. Rabies immunoglobulin should be administered as soon as possible after exposure.
The recommended dose for both adults and children is 40 IU/kg body weight. If feasible, as much of the dose as possible should be infiltrated in and around the wound(s), with the remaining amount administered intramuscularly (preferably in the gluteal region) as a single injection.
In children, especially with multiple wounds, the dose may be diluted 2–3 times with 0.9% sodium chloride solution to ensure adequate infiltration of all wounds. In sensitive areas such as fingertips, careful infiltration is necessary to avoid excessive tissue pressure.
For rabies prevention, the combined administration of rabies immunoglobulin and vaccine is recommended. The first dose of rabies vaccine should be given at the same time as immunoglobulin, but at a different anatomical site. If immunoglobulin is not available at the time of vaccination, it may be administered up to the 7th or 8th day after the first vaccine dose. Anti-tetanus treatment and antimicrobial therapy should be initiated when indicated to manage other infections.
The WHO expert committee on rabies has issued the following therapeutic recommendations:
Category Type of contact with a suspect or confirmed rabid domestic or wild animal or animal not available for observation Recommended Treatment:
- Touching or feeding animals, or licks on intact skin: No treatment required if reliable history is available.
- Minor scratches, nibbling of uncovered skin without bleeding, or licks on broken skin: Administer rabies vaccine immediately on days 0, 3, 7, 14, and 28. Discontinue treatment if the animal remains healthy during 10 days of observation or tests negative for rabies.
Single or multiple transdermal bites or scratches, especially on head, neck, shoulder, arms, or hands; contamination of mucous membranes with saliva: Administer rabies vaccine on days 0, 3, 7, 14, and 28, along with rabies immunoglobulin on day 0. Treatment may be stopped if the animal remains healthy after observation or is confirmed negative.
