🚑 EmergencyInfectious / EmergencyStudentInternResident

Animal Bite & Rabies Prophylaxis

Also known as: dog bite · rabies · post-exposure prophylaxis · PEP · ASV of rabies

Rabies is almost 100% fatal once symptomatic but almost 100% preventable with correct post-exposure prophylaxis (PEP). Treat every mammal bite as an emergency for wound care and risk assessment.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — confirm the current national rabies PEP schedule before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Anyone bitten, scratched, or licked on broken skin by a mammal — dogs cause most human rabies in India; cats, monkeys, and bats also transmit.

Red flags — escalate / refer

Category III exposure (transdermal bites/scratches, licks on broken skin, mucous-membrane contact) → give vaccine PLUS rabies immunoglobulin (RIG).
Established rabies (hydrophobia, aerophobia, agitation) is almost universally fatal → palliative care.
Bites to the face/hands/genitals or in the immunocompromised are higher risk.

Work-up / diagnosis

1Categorise the exposure (WHO Category I / II / III) to decide PEP — do NOT wait for any test to start.
2Assess the biting animal (provoked?, vaccinated?, available for 10-day observation) and the wound(s).
3Check tetanus immunisation status.

Management — overview

Immediately wash the wound with soap and running water for ~15 minutes and apply a virucidal (e.g. povidone-iodine); avoid immediate suturing where possible.
Category II: wound care + a full rabies vaccine course.
Category III (or any exposure if immunocompromised): wound care + vaccine + infiltrate rabies immunoglobulin (RIG) into and around the wound.
Give tetanus prophylaxis and wound antibiotics when indicated; start PEP as early as possible and complete the schedule.

In-depthFull dosing & advanced protocol

Drug dosing

Rabies vaccine (cell-culture)

Category II & III exposure

Adult dose: Per a current WHO-approved schedule (intradermal or intramuscular), starting day 0 — complete the full course
Route: Intradermal / intramuscular

Caution: Previously fully vaccinated: give booster doses only, no RIG.

WHOWHO — Rabies & post-exposure prophylaxis ↗

Rabies immunoglobulin (RIG)

Category III (with the first vaccine dose only)

Adult dose: Infiltrate as much as feasible around the wound(s): human RIG 20 IU/kg, or equine RIG 40 IU/kg
Route: Wound infiltration

Caution: Give with the first vaccine dose (not later); confirm the current national schedule.

MoHFWNCDC, India — National Rabies Control Programme guidelines ↗

Wound antibiotic (e.g. amoxicillin-clavulanate)

Prophylaxis for higher-risk bite wounds

Adult dose: Per local guidance; add tetanus prophylaxis
Route: Oral

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Categories, regimens & re-exposure

WHO Category I (touching/feeding, licks on intact skin) needs no PEP; II (minor scratches/abrasions, no bleeding) needs vaccine; III needs vaccine + RIG.
Both intradermal and intramuscular cell-culture regimens are WHO-approved — follow the national schedule.
Previously vaccinated individuals need only booster doses and no RIG on re-exposure.

WHOWHO — Rabies & post-exposure prophylaxis ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

AnaphylaxisAcute, life-threatening systemic hypersensitivity with airway, breathing or circulation compromise within minutes of a trigger. Intramuscular adrenaline is the immediate, life-saving treatment.Snakebite EnvenomationA medical emergency from a venomous snakebite. In India the “Big Four” (cobra, krait, Russell's viper, saw-scaled viper) cause neurotoxic and/or haemotoxic envenomation. Polyvalent anti-snake venom (ASV) is the antidote; many bites are “dry”.Sepsis & Septic ShockLife-threatening organ dysfunction from a dysregulated host response to infection. Early recognition and the “hour-1 bundle” save lives; septic shock adds fluid-refractory hypotension.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Rabies vaccine (cell-culture)

Rabies immunoglobulin (RIG)

Wound antibiotic (e.g. amoxicillin-clavulanate)

📈 Categories, regimens & re-exposure

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Rabies vaccine (cell-culture)

Rabies immunoglobulin (RIG)

Wound antibiotic (e.g. amoxicillin-clavulanate)

📈 Categories, regimens & re-exposure

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Categories, regimens & re-exposure

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Categories, regimens & re-exposure

References