Immediately or as early as possible after a bite or injury, a mandatory local wound treatment is performed. Wounds are abundantly washed with soap and water or any detergent and treated with 40-70% alcohol or 5% alcohol solution of iodine. In cases where there are indications, surgical treatment of the wound is performed.
After the local treatment of the wound, a specific treatment immediately begins. Before the injection, check the integrity of the bottle and the presence on it of the label. The preparation is not suitable for use in vials with broken integrity, marking, as well as when changing its physical properties (color, transparency, etc.), expired shelf life, in violation of the storage regime.
Opening of vials and the procedure for administering the drug are carried out with strict adherence to aseptic and antiseptic rules.
The skin test is not required before administration.
The drug is administered as soon as possible after treatment once in a dose of 20 IU / kg body weight of an adult or child.
Example of calculating the dose of immunoglobulin:
The weight of the injured person is 60 kg.
For example, the actual activity of the immunoglobulin of this series, indicated on the label of the vial or on the package, is 200 IU / ml.
In order to determine the dose of immunoglobulin necessary for administration in ml, the weight of the injured (60 kg) should be multiplied by 20 ME and divide the resultant number by the drug activity (200 IU / ml), i.e.
60x20/200 = 6 ml
As much as possible of the calculated dose should be infiltrated around and into the wound, if possible anatomically.
The rest should be introduced intramuscularly:
- for adults: in the upper outer quadrant of the gluteus muscle;
- for children: in anterolateral lateral surface of thigh.
For children (especially those with multiple wounds), the dose of rabies immunoglobulin from human blood serum can be diluted 2-3 times with a sterile 0.9% solution of sodium chloride to a volume that provides full infiltration of the affected parts of the body.
Anti-rabies immunoglobulin from human blood serum is administered no later than 7 days after exposure to rabies or rabid animals suspected of rabies.
Rabies immunoglobulin from human serum is used in combination with rabies vaccine at the third category of damage, a detailed description of the nature of contact with the animal, the data on it, and the regimen described in the table below:
The scheme therapeutic and prophylactic vaccination with rabies vaccine and rabies immunoglobulin from human serum (Arik)
| Category damages | Nature of contact | Data on the animal | Treatment |
| 1 | There are no damages to the skin, there are no discomforts of the skin, there are no mucus membranes | A patient with rabies | Not assigned |
| 2 | Misleading intact skin, abrasions, scratches, bites the surface of the trunk, upper and lower extremities (except for areas of the head, face, neck, hands, fingers and toes) caused domestic and farm animals | If, within 10 days of monitoring the animal, it remains healthy, then the treatment is discontinued (ie after the 3rd injection). If laboratory evidence of the absence of rabies in an animal, the treatment is discontinued from the moment of establishment of absence of rabies. In all other cases, it is not possible 10-day observation of the animal (killed, died, escaped, disappeared, and so forth.)treatment continues according to the scheme | Initiate treatment immediately: a 1.0 ml vaccine at 0, 3, 7, 14, 30 and 90 days |
| 3 | Any mucus membranes, any bites of the head, face, neck, hand, fingers and toes, genitals; single or multiple deep ragged wounds inflicted by domestic or farm animals. Any damnation and damage caused by wild carnivorous animals, bats and rodents | If, within 10 days of monitoring the animal, it remains healthy, then the treatment is discontinued (ie after the 3rd injection). If laboratory evidence of the absence of rabies in an animal, the treatment is discontinued from the moment of establishment of absence of rabies. In all other cases where it is impossible to observe the animal for 10 days, the treatment is continued according to the indicated scheme | Initiate immediate combination treatment Immunoglobulin anti-rabies from human serum at 0 day and anti-rabies vaccine: 1.0 ml per 0, 3, 7, 14, 30 and 90 days. |
Combined immunoglobulin anti-rabies treatment of human serum and anti-rabies vaccine should be carried out with strict adherence to the following conditions:
- First enter Antimicrobial immunoglobulin from human blood serum, and no more than 30 minutes after it is administered an anti-rabies vaccine.
It is necessary to strictly adhere to the sequence of administration of anti-rabies drugs!
Introduction of ARIG after administration of rabies vaccine not allowed.
- Immunoglobulin anti rabies and rabies vaccine should be injected into different parts of the body using different syringes.
The dosage of immunoglobulin should not be exceeded under any circumstances, since the administration of an increased dose of immunoglobulin can partially suppress the production of antibodies.
If necessary, emergency prophylaxis of tetanus is carried out after the introduction of immunoglobulin anti-rabies and the first vaccination of rabies vaccine.