DOG BITE TRETMENT

August 31, 2025

🐶 Rabies – Dog Bite Prophylaxis (PEP)

1. Wound Management

Immediate washing of the wound with soap and running water for at least 15 minutes.
Apply povidone-iodine / alcohol-based disinfectant.
Do NOT immediately suture unless necessary (delayed primary closure preferred).

2. Classification of Exposure (WHO Guidelines)

Category I: Touching/feeding animals, licks on intact skin → No PEP required.
Category II: Nibbling of uncovered skin, minor scratches without bleeding → Vaccine only.
Category III: Single/multiple transdermal bites/scratches, licks on broken skin, contamination of mucous membrane, exposure to bats → Vaccine + Rabies Immunoglobulin (RIG).

3. Rabies Vaccine (for Category II & III)

WHO-approved cell culture vaccine (e.g., Purified Vero cell vaccine, PCECV).
Schedule (IM, Essen regimen):
- Days 0, 3, 7, 14, 28 (5 doses in deltoid/thigh).
Intradermal (ID, Thai Red Cross regimen):
- Days 0, 3, 7, 28 (2-site ID, 0.1 ml each).
Day 0 = day of first dose (not the day of bite).

4. Rabies Immunoglobulin (RIG) – for Category III only

Types:
- Human RIG (HRIG): 20 IU/kg body weight.
- Equine RIG (ERIG): 40 IU/kg body weight.
Administration:
- As much as possible infiltrated around the wound.
- Remaining amount IM at a site away from vaccine injection.

5. Tetanus Prophylaxis & Antibiotics

Tetanus vaccine / booster as per immunization status.
Antibiotics (e.g., Amoxicillin-Clavulanate) for infected wounds.

6. Pre-exposure Prophylaxis (for high-risk groups – veterinarians, lab workers, frequent dog handlers)

3 doses: Days 0, 7, 21 or 28.
If exposed: only 2 booster doses (Day 0, 3) required, no RIG needed.

✅ Key Point: Rabies is 100% fatal once symptoms develop, but 100% preventable with proper prophylaxis.

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