Prevention of rabies after categoryIII exposure (except in patients who have received a full course of pre-exposure prophylaxis against rabies),in combination with rabies vaccine
Prevention of rabies after category II and III exposures in immuno compromised patients(even in patients who have received a full course of pre-exposure prophylaxis against rabies), in combination with rabies vaccine
Forms and strengths, route of administration
Solution for injection, 300 IU in 1 ml ampoule (300 IU/ml) and 1500 IU in 5 ml ampoule(300 IU/ml) for infiltration into and around the wound
Dosage and duration
Child and adult: 20 IU/kg single dose on D0, along with the first dose of rabies vaccine.
Infiltrate as much of the dose as possible into and around the wound(s),which has been cleaned beforehand.
In the event of multiple wounds, dilute the dose 2 to 3-fold with sterile 0.9% sodium chloride to obtain a sufficient quantity to infiltrate all the sites.
If HRIG is not available on D0, administer the first dose of rabies vaccine alone. Administer HRIG as soon as possible between D0 and D7; from D8, it is not necessary to administer rabies immunoglobulin as vaccine-induced antibodies begin to appear.
Contra-indications, adverse effects, precautions
May cause: fever, headache, gastrointestinal disturbances, joint pain, local reactions at the injection site (pain, inflammation); rarely: anaphylactic reactions.
Aspirate prior to injection to confirm that the needle is not in a vein and ensure that the HRIG does not enter a blood vessel (risk of shock).
For finger wounds, infiltratewith caution to avoid increased pressure in the tissue compartment.
If administered simultaneously with rabies immunoglobulin and other vaccines, use different syringes and injection sites.
Pregnancy and breast-feeding: no contra-indication
Remarks
Purified equine rabies immunoglobulin F(ab’)2 fragments may replace HRIG if unavailable. The method of administration is the same but the dose is 40 IU/kg.