Rabies postexposure prophylaxis

After a patient has been exposed to rabies, the treatment objectives consist of thorough irrigation of the wound, tetanus prophylaxis, antibiotic prophylaxis, if indicated, and immunization. Prompt, thorough irrigation of the wound with soap or iodine solution may reduce the development of rabies. Postexposure prophylaxis immunization consists of the administration of both passive antibody and vaccine. The only exceptions to antibody administration are patients who have been immunized previously and have the appropriate degree of documented rabies antibody titers. 

If a patient has been exposed to rabies, the treatment objectives consist of thorough irrigation of the wound, tetanus prophylaxis, antibiotic prophylaxis (if indicated), and immunization. Postexposure prophylaxis immunization consists of both passive antibody administration and vaccine administration. 

Treatment involves the application of rabies-specific antibodies that are infiltrated around the bite wound, in addition to immunization. The antibodies provide passive protection and are able to neutralize the virus. For developing countries, these antibodies are both too expensive and difficult to produce in large quantities. In addition to this, there is a dramatic shortage of rabies monoclonal antibodies (MAbs) available on a worldwide basis. The production of inexpensive and safe plant-derived MAbs would be useful in postexposure prophylaxis-global health benefit. 

Postexposure Five-doses at days 0, 3, 7, 14, and 28 2. Postexposure prophylaxis (administer with rabies immune globulin)... 

Human diploid cell vaccine (HDCV), rabies vaccine adsorbed (RVA), and purified chick embryo cell culture rabies vaccine (PCEC) are killed vaccines used for preexposure and postexposure rabies virus prophylaxis. Transmission of rabies can occur via percutaneous, per-mucosal, or airborne exposure to the rabies virus. Circumstances favoring such transmission include animal bites or attacks and contamination of scratches, cuts, abrasions, or mucous membranes with saliva or other infectious material (brain tissue). Unprovoked attacks and daytime attacks by nocturnal animals are considered highly suspect. Common wild animal transmitters include skunks, coyotes, foxes, and raccoons. Almost 60% of human rabies deaths in the United States since 1980 were associated with bat contact. Canine rabies is very common in many foreign countries (most of Asia, Africa, and Latin America). Rodents, rabbits, and hares are infected rarely. There have been a few reports of a person-to-person transmission. ... 

Rabies Rabies immune globulin 20 IU/kg. The full dose should be infiltrated around the wound and any remaining volume should be given IM at an anatomic site distant from vaccine administration. Postexposure rabies prophylaxis in persons not previously immunized with rabies vaccine. Must be combined with rabies vaccine. 

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