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.

 

MBWA! Evidence based Dog Bite Management

  • It appears safe to close all dog bites regardless of location as long as they are < 8 hours old, and copious high-pressure irrigation
  • In patients with non-hand location dog bites, antibiotics are not needed if we leave the wound open for secondary repair.
  • If we primarily close the wound, we should continue to provide antibiotic prophylaxis until someone performs a randomized trial of primary closure +/- antibiotic prophylaxis.

 

Medical Myths in the Management of Dog Bites

  • It appears safe to close all dog bites regardless of location as long as they are < 8 hours old, and copious high-pressure irrigation
  • In patients with non-hand location dog bites, antibiotics are not needed if we leave the wound open for secondary repair.
  • If we primarily close the wound, we should continue to provide antibiotic prophylaxis until someone performs a randomized trial of primary closure +/- antibiotic prophylaxis.