This may be considered under 3 heads
- Post–exposure prophylaxis.
- Pre–exposure prophylaxis.
- Post–exposure treatment of persons who have been vaccinated previously.
General consideration
The vast majority of persons requiring anti–rabies treatment are those who were bitten by a suspected rabid animals.
Local Treatment of wound
Prompt and adequate local treatment of all bite wounds and scratches is the first requisite and is of utmost importance. The purpose of local treatment is to remove as much virus as possible from the site of inoculation before it can be absorbed on nerve endings.
- Cleansing
Immediate flushing and washing the wound(s) scratches and the adjoining areas with plenty of soap and water, preferably under a running tap, for atleast 5 minutes is of paramount importance in the prevention of human rabies. If soap is not available simple flushing of the wounds with plenty of water should be done as first–aid. - Chemical treatment
Whatever residual virus remains in the wound(s), after cleansing, should be inactivated by irrigation with virucidal agents – either alcohol (400–700 ml/litre), tincture or 0.01% aqueous solution of iodine or povidone iodine. - Suturing
Bite wounds should be immediately sutured to prevent additional trauma which may help spread the virus in to deeper tissues. If suturing is necessary, it should be done 24–48 hours later, applying minimum possible stitches, under the cover of anti–rabies serum locally. - Anti–rabies serum
The local application of anti–rabies serum or its infiltration around the wound has been shown to be highly effective in preventing rabies. The sensitivity of the patient should be tested prior to its use. - Antibiotics and anti–tetanus measure
The application of antibiotics and anti–tetanus procedures when indicated should follow the local treatment recommended above.
| Category | Type of contact with a suspect or confirmed rabid domestic or wild animal, or animal unavailable for observation. | Recommendations |
| 1 | Touching or feeding of animals, licks on intact skin. | None, if reliable case history is available. |
| 2 | Nibbling of uncovered skin Minor scratches or abrasions without bleeding Licks on broken skin. | Administer vaccine immediately stop treatment if animal remains healthy throughout an observation period of 10 days or if animal is killed humanely and found to be negative for rabies by appropriate laboratory techniques. |
| 3 | Single or multiple transdermal bites or scratches Contamination of mucous membrane with saliva (i.e. licks). | Administer rabies immunoglobulin and vaccine immediately. Stop treatment if animal remains healthy throughout an observation period of 10 days or if animal is killed humanely and found to be negative for rabies by appropriate laboratory techniques. |
