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

A dog bite with skin penetration is classified as $\text{WHO Category III}$ rabies exposure.

Management protocol:

1. Immediate wound care: Wash the wound with soap and water for at least 15 minutes; apply povidone iodine or 70% ethanol.

2. Rabies Immunoglobulin (RIG): $20 \text{ IU/kg}$ of human RIG (HRIG). Maximum dose infiltrated directly into and around the wound; remainder at a distant IM site. Provides immediate passive immunity. Must be given on Day 0 with the first vaccine dose.

3. Rabies vaccine (active immunisation): Two accepted schedules:
- Essen: Days 0, 3, 7, 14, 28 (5 doses)
- Zagreb: Days 0 (2 doses), 7, 21 (4 doses)

Antibiotics (e.g., amoxicillin-clavulanate) are added to prevent secondary bacterial wound infections but do not protect against rabies.

If the animal is healthy and available for 10-day observation and remains healthy, PEP may be stopped after 3 doses.

\[\boxed{\text{Wound wash + Rabies vaccine + RIG (Category III)}}\]