Rabies Post-Exposure Prophylaxis Guidelines

Standard Post-Exposure Prophylaxis Regimen

The Centers for Disease Control and Prevention recommends administering 4 doses of rabies vaccine intramuscularly on days 0, 3, 7, and 14, combined with human rabies immune globulin (HRIG) at 20 IU/kg on day 0 for previously unvaccinated individuals 1, 2, 3
The vaccine schedule consists of 1.0 mL of HDCV or PCECV administered intramuscularly on days 0, 3, 7, and 14, with day 0 defined as the day the first dose is administered 1, 2, 3
HRIG should be administered at 20 IU/kg body weight on day 0, ideally at the same time as the first vaccine dose, and infiltrated around and into the wound(s) if anatomically feasible 1, 2, 3, 4

For previously vaccinated persons, the American College of Physicians recommends a simplified 2-dose regimen of 1.0 mL each on days 0 and 3, without HRIG administration 1, 2, 3, 4
Immunocompromised patients require a critical modification of the full 5-dose regimen on days 0, 3, 7, 14, and 28, with HRIG at 20 IU/kg on day 0 2, 3, 4
Pediatric patients receive the same vaccine dose volume (1.0 mL) as adults, with the anterolateral thigh used for vaccine administration in young children 1, 2

Immediate local treatment involves thoroughly washing all wounds with soap and water for 15 minutes before any other intervention 2, 3
Irrigation with a virucidal agent such as povidone-iodine solution is recommended if available 3

Post-exposure prophylaxis should be initiated as soon as possible after exposure, ideally within 24 hours, with no absolute cutoff beyond which treatment should be withheld 2
Delays of a few days for individual doses are unimportant, but missed doses should be administered immediately when the patient presents, and the schedule resumed maintaining the same intervals 2, 5

The Centers for Disease Control and Prevention advises against administering vaccine in the gluteal area, giving HRIG in the same syringe or anatomical site as vaccine, exceeding the recommended HRIG dose of 20 IU/kg, and giving HRIG to previously vaccinated persons unless they are immunocompromised 1, 2, 3, 4

When administered promptly and appropriately, the post-exposure prophylaxis regimen combining wound care, HRIG infiltration, and the vaccine series is nearly 100% effective in preventing human rabies 2, 3