Dhirendra Tripathi

If a dog bites then next steps: Dog bite. Vaccination status unknown. Treat it as rabies exposure until proven otherwise. 1) Start with the wound. Immediately. •Wash under running water + soap for at least 15 minutes •Do not be gentle. Mechanical washing saves lives •Apply povidone-iodine or chlorhexidine after washing •Avoid tight suturing unless necessary (and preferably delayed) 2) Assess exposure (this decides urgency) Category II – scratches, minor bites without bleeding Category III – bites that break skin, bleeding, saliva on mucosa Unknown dog = assume Category III if any doubt 3) Rabies prophylaxis (do not delay) Rabies vaccine (PEP) Start immediately, day 0. Common schedule: •Day 0, 3, 7, 14 (± day 28 depending on protocol) Do not wait for symptoms. Once symptoms appear, rabies is almost always fatal. Rabies Immunoglobulin (RIG) : for Category III •Infiltrate into and around the wound •Any remaining volume IM at a distant site •Given once, on day 0 This provides immediate passive immunity while vaccine builds response. 4) Tetanus prophylaxis •Give tetanus toxoid if not up to date •Add tetanus immunoglobulin if high-risk wound and uncertain history 5) Antibiotics (dog bites are dirty wounds) Common choice: •Amoxicillin-clavulanate Covers: •Pasteurella •anaerobes •skin flora 6) Observe the dog (if possible) •If the dog remains healthy for 10 days, rabies risk is low •If the dog becomes ill or dies → continue full treatment without hesitation 7) What NOT to do •Do not ignore “small” bites •Do not rely on home remedies •Do not delay vaccine waiting for lab confirmation Bottom line In suspected rabies exposure, time = survival. Wash aggressively. Start vaccine immediately. Add immunoglobulin when indicated. Everything else is secondary.