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Clinical Guidelines

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Rabies vaccines and immunoglobulins: WHO position

PEP consists of the following steps:

  1. All bite wounds and scratches should be attended to as soon as possible after the exposure; thorough washing and flushing of the wound for approximately 15 minutes, with soap or detergent and copious
    amounts of water, is required. Where available, an iodine-containing, or similarly viricidal, topical
    preparation should be applied to the wound.
  2. RIG should be administered for severe category III exposures. Wounds that require suturing should be
    sutured loosely and only after RIG infiltration into the wound.
  3. A series of rabies vaccine injections should be administered promptly after an exposure.

Surviving Sepsis Guidelines 2021: Recommendations and Best Practice Statements

  • The recommendation for an initial fluid bolus of 30 mL/kg was downgraded from a strong recommendation to a weak recommendation, based on the low quality of evidence. However, resuscitation should start immediately.
  • Balanced crystalloid solution (e.g., lactated Ringer’s solution) should be used (rather than normal saline) for resuscitation.
  • Administration of vasopressors should be initiated via peripheral access, as opposed to waiting for placement of central venous access.
  • Patients with ongoing vasopressor requirements should receive intravenous corticosteroids (this recommendation was strengthened); however, administration of intravenous vitamin C is explicitly not recommended.
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