Question

A patient presents after a dog bite. How will you treat this patient?

• A. Rabies vaccine alone
• B. Rabies immunoglobulin (RIG) alone
• C. Wound washing, rabies vaccine, and rabies immunoglobulin (RIG) for category III exposure
• D. Antibiotics alone (amoxicillin-clavulanate)

Hint:

Classify the dog bite as a WHO Category III exposure and recall the three-pronged post-exposure prophylaxis approach.

Answer 1

The Correct Option is C

Step 1: Classify the exposure (WHO category). A dog bite is classified as:
- Category I: Touching or feeding animals, licks on intact skin -- no treatment needed
- Category II: Nibbling of uncovered skin, minor scratches without bleeding -- wound washing + vaccine
- Category III: Single or multiple transdermal bites or scratches, contamination of mucous membranes -- wound washing + rabies vaccine + rabies immunoglobulin (RIG)
A dog bite with skin penetration is Category III.

Step 2: Immediate wound care. The wound should be thoroughly washed immediately with soap and water for at least 15 minutes, then treated with a virucidal agent (povidone iodine or 70% alcohol). This step alone can significantly reduce the risk of rabies transmission.

Step 3: Rabies post-exposure prophylaxis (PEP). For Category III:
- Rabies Immunoglobulin (RIG): Administered as soon as possible on day 0. Human RIG (HRIG) 20 IU/kg body weight; as much as possible infiltrated into and around the wound, remainder given IM at a site distant from vaccine injection. This provides immediate passive immunity.
- Rabies vaccine: Active immunisation. Schedules include Essen (5-dose: days 0, 3, 7, 14, 28) or Zagreb (2-1-1: 2 doses day 0, 1 dose day 7, 1 dose day 21).

Step 4: Antibiotic coverage. Amoxicillin-clavulanate is given to prevent secondary bacterial infection from dog bite wound flora, but it is NOT the primary treatment for rabies prevention.

Conclusion: For a dog bite (Category III), wound washing + rabies vaccine + rabies immunoglobulin (RIG) is the correct management.