Treatment Guideline and Explanation
Wound management:
- Proper wound toileting. Application on viricidal agents like rectified spirit, povidone iodine, tincture iodine to eliminate as much virus as possible.
- Antibiotics prophylaxis to avoid secondary infection
- Tetanus prophylaxis if tetanus vaccination status is uncertain
- Suturing must be generally avoided as a rule as it may risk inoculation of the virus deeply into the wound. If suturing is done, it should be done under local infiltration of anti-rabies serum. If anti-rabies serum (ARS) is not available, as a last resort the wound must be thoroughly flushed with at least povidone iodine or tincture iodine before suturing
- Generally, animal bite wounds should not be dressed or bandaged and if unavoidable it should be loose and not occlusive.
Anti-rabies vaccine (ARV):
Cell culture vaccines e.g. Purified Vero Cell Rabies Vaccine & Purified Chick Embryo Cell Vaccine, total 4 doses.
- 0.1 ml/dose intradermally into 2 sites (in case of an adult: in each deltoid muscle and in case of children < 2 years: at anterolateral thigh),
- on Day 0, Day 3, Day 7 and Day 28.
Rabies immunoglobulin (RIG):
In Category III injury e.g. single or multiple transdermal bite or scratches, licks or broken skin.
