Small Volume of Rabies Immunoglobulin (RIG) is Effective for Local Wound Infiltration in Rabies Post-Exposure Prophylaxis whereas Intramuscular RIG is just a Wastage

Rabies is a zoonosis that is 100% fatal once symptoms of the disease appear. However, it is almost 100% preventable if the prophylactic measures with proper wound wash, vaccines and immunoglobulins are taken soon after exposure to the animal bite. A general tendency has been noticed among clinicians all over the world to inject Rabies Immunoglobulins (RIG) intramuscularly, mostly in the gluteal muscle, despite the guidelines that suggest infiltrating it into the wounds. This has resulted in failures of Post Exposure Prophylaxis in many countries leading to the death of patients due to rabies. Here we discuss how giving any amount or even large amount of RIG intramuscularly (IM) is not going to neutralise rabies virus at the wound site especially during the window period, exposing the patients to the risk of rabies, whereas a small volume of RIG injected into the wound(s) is a lifesaving intervention as it neutralises the virus there and then in the wound(s) especially during the initial window period when the exposed person is unprotected, as the response to concurrent vaccination may take 10-14 days after exposure/ bite.</jats:p

Local Wound Spray of “Standardised Herbal Antibiotic Extract” on Snakebite Wounds along with Routine Anti Snake Venom Treatment Saves Lives, Limbs and Livelihood of Snakebite Victims in Rural Maharashtra, India - 15 Case Reports as Pilot

Background: Globally between 81,000 and 138,000 people around the world die each year from snakebite. Authors noticed that the use of oral/ systematic antibiotics in many snakebite victims failed to heal the snakebite wounds, and either the patients required skin grafting or the bitten part developed necrosis and needed amputation.Objectives: Authors after an extensive literature review thought of neutralising bacteria at the snakebite site by a potent antimicrobial spray, without any side effects.Method: Authors decided to get the antimicrobial profile of herb X and found that it can neutralise the bacteria that are resistant even to the most potent antibiotics available.Results: Herbal extract (234 ml) was prepared for pilot use in snakebite patients. A series of 15 patients were sprayed 2 puffs (7-10 ml) of ready to use herbal spray. None of them developed extensive blisters except the two patients who had mild blisters which resolved subsequently without any deep wound as used to be the case earlier.Conclusion: This pilot project has shown promising results and needs to be applied in more cases in future.</jats:p

Injecting rabies immunoglobulin (RIG) into wounds only: A significant saving of lives and costly RIG

An increasing number of dog bite victims were being presented to public hospitals in Himachal Pradesh in 2014 amidst virtual non availability of any rabies immunoglobulin (RIG). Only a small quantity of equine rabies immunoglobulin (eRIG) was available from the government owned Central Research Institute (CRI) Kasauli. This available eRIG was used in 269 patients as an emergency response and only for local infiltration of severe bite wounds by suspected rabid dogs. This was followed by rabies vaccination, using the WHO approved intra-dermal Thai Red Cross Society vaccination schedule. A subgroup of 26 patients were later identified who had been severely bitten by laboratory confirmed rabid dogs. They were followed for more than one year and all were found to be alive