Immediately or as early as possible after a bite or injury, local wound treatment: the wound surface is abundantly washed with water with soap (or detergent), and the edges of the wound are treated with 70% alcohol or 5% alcoholic iodine solution.
Immediate suturing of the wound is contraindicated; if necessary, a simple connection of its edges is permissible. The application of sutures is shown exclusively in the following cases: with extensive wounds - several leading skin seams after pre-treatment of the wound; on cosmetic indications (imposition cutaneous sutures on the wounds of the face); stitching of bleeding vessels to stop external bleeding.
After the local processing wounds immediately begin treatment and prophylactic immunization. AIG should be administered no later than three days after a bite or damage to a rabid or suspicious rabies animal. The most effective administration of the drug in the first day after the injury.
Before the injection, check the integrity of the ampoules and the presence of markings on them.The preparation is not suitable for use: in ampoules with broken integrity, marking, as well as when changing its physical properties (color, transparency, etc.), expired, with improper storage.
Opening of ampoules and the procedure for administering the drug are carried out with strict adherence to aseptic and antiseptic rules.
AIG should be administered exclusively in combination with an antirabic vaccine, the first administration of which is performed no more than 30 min after the administration of AIG in a dose of 1 ml. The scheme of treatment of AIG and an anti-rabies vaccine is indicated in Table 1.
Table 1. Scheme of treatment-and-prophylactic vaccinations with anti-rabies vaccine (AB) and rabies immunoglobulin (AIG)
| 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 and mucous membranes. | She is sick with rabies. | Not appointed. |
| 2 | Inflammation of intact skin, abrasions, scratches, single superficial bites of the trunk, upper and lower extremities (except bites of dangerous localization: head, face, neck, hand, fingers and toes) caused by domestic and farm animals | If, within 10 days of monitoring the animal, it remains healthy, then the treatment is terminated (i.e. after the 3rd injection).
If laboratory evidence of the absence of rabies in an animal, the treatment is discontinued from the moment establishing the absence of rabies.
In all other cases, when it is impossible to observe the animal for 10 days (killed, killed, run away, etc.), continue treatment according to the indicated scheme. | Start treatment immediately: AB on 1,0 ml at 0, 3, 7, 14, 30, 90 day. |
| 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 and farm animals. Any damnation and damage caused by wild carnivorous animals, bats and rodents. | If it is possible to observe the animal, and it remains healthy for 10 days, the treatment is stopped (i.e. after the 3rd injection).
If laboratory evidence of the absence of rabies in an animal, the treatment is discontinued from the moment establishing the absence of rabies.
In all other cases, when it is impossible to observe the animal, continue treatment according to the indicated scheme. | Initiate immediate combined treatment with an antirabies immunoglobulin: AIG on day 0 and an antirabic vaccine: AB at 1.0 ml at 0, 3, 7, 14, 30 and 90 days. |
AIG injected at a dose of 40 IU per 1 kg of body weight of an adult or child. Scope injected AIG should not exceed 20 ml.
Example: body weight of the victim 60 kg; activity of AIG (indicated on ampoules and packs with the drug), for example, 200 IU per ml. In order to determine (60 kg) multiply by 40 ME and divide the obtained number by the activity of the drug (200 ME), that is:
60x40 / 200 = 12 ml
Before the introduction of AIG to detect sensitivity to a foreign protein, an intradermal test with an immunoglobulin, an antirabic diluted 1: 100 (ampoules marked in red), which is in a box with an undiluted preparation (ampoules marked in blue), is mandatory.
The diluted 1: 100 immunoglobulin is administered in a volume of 0.1 ml intradermally to the flexor surface of the forearm.
The sample is considered negative if after 20-30 minutes there is no swelling or redness at the injection site or less than 1 cm. The sample is considered positive if the swelling or redness reaches 1 cm or more.
If the reaction is negative, 0.7 ml of anti-rabies diluted 1: 100 immunoglobulin is injected subcutaneously into the shoulder region. If no reaction occurs after 30 minutes, the entire calculated dose of AIG heated to 37 ± 0.5 ° C is injected fractionally in 3 divided doses at intervals of 10-15 minutes, taking the preparation for each portion from unopened vials.
The calculated dose of AIG should be infiltrated around the wounds and in the depth of the wound. If the anatomical location of the lesion (fingertips, etc.) does not allow the entire dose to be introduced around the wounds, the rest of AIG is administered intramuscularly to a site other than the introduction of the vaccine (buttock muscles, upper outer thigh, shoulder).
The introduction of AIG and an anti-rabies vaccine should not be carried out on the same shoulder.
The entire dose of AIG is administered within one hour.
The most effective administration of the drug in the first day after the injury, but no later than three days.
With a positive intradermal test (swelling or redness of 1 cm or more) or in case of an allergic reaction to a subcutaneous injection of AIG are administered with special precautions. First, it is recommended to introduce an immunoglobulin diluted 1: 100 in the subcutaneous tissue of the shoulder in doses of 0.5 ml, 2.0 ml, 5.0 ml with an interval of 15-20 minutes,then inject 0.1 ml of undiluted immunoglobulin and after 30-60 minutes intramuscularly administered the entire prescribed dose of the drug heated to 37 ± 0.5 ° C, divided into 3 divided doses at intervals of 10-15 minutes.
Before the first injection, parenteral administration of antihistamines (suprastin, dimedrol, etc.) is recommended. In order to prevent shock at the same time as the introduction of AIG, subcutaneous administration of a 0.1% solution of epinephrine or a 5% solution of ephedrine at age dosage is recommended:
When you introduce AIG, you should always have ready-made solutions of epinephrine, ephedrine, dimedrol or suprastin.
After the introduction of AIG, the patient should be under medical supervision for at least 1 hour. The first vaccination with an anti-rabies vaccine is carried out on the day of introduction of AIG after administration of the latter. The vaccine is recorded in the prescribed registration forms with the indication of the dose, the date, the manufacturer of the drug, the number of the series, the response to the introduction.