Скачать или смотреть MANAGEMENT OF RABIES LECTURE #44 PHARMACY PRACTICE CLINICAL PHARMAC-II. DOG & CAT BIT

Certainly! Here's a comprehensive overview of clinical pharmacy practice management of rabies, including diagnosis, treatment, prophylaxis, and references.

Clinical Pharmacy Practice Management of Rabies

Introduction
Rabies is a viral zoonotic disease caused by the rabies virus, primarily transmitted through the saliva of infected animals via bites. It is almost universally fatal once clinical symptoms appear, but it is preventable through timely post-exposure prophylaxis (PEP).

1. Assessment & Diagnosis
History:** Animal bite or scratch, especially from unvaccinated or wild animals.
Clinical signs:** Often asymptomatic initially; once neurological symptoms develop (hydrophobia, aerophobia, paralysis), the disease is nearly always fatal.
Laboratory diagnosis:** Usually post-mortem; ante-mortem testing includes detection of rabies virus RNA or antigen in saliva, CSF, skin biopsies, or saliva samples via RT-PCR or DFA (direct fluorescent antibody test).

Note: Diagnosis is mainly clinical; laboratory confirmation supports but does not alter immediate management.

2. Management of Rabies Exposure

A. Wound Care
Immediate, thorough washing of the wound with soap and water for at least 15 minutes.
Use of antiseptics (e.g., povidone-iodine).

B. Post-Exposure Prophylaxis (PEP)
PEP is highly effective if administered promptly after exposure. It includes rabies vaccine and rabies immunoglobulin (RIG) as appropriate.

3. Rabies Prophylaxis

A. Human Rabies Immune Globulin (HRIG)
Indication:** Category III exposures (e.g., transdermal bites, scratches that break the skin).
Dosing:** 20 IU/kg body weight, infiltrated locally around the wound(s). Any remaining volume should be administered IM at a site distant from vaccine administration.

B. Rabies Vaccines
Types:** Human diploid cell vaccine (HDCV), Purified Chick Embryo Cell vaccine (PCEC), or other WHO-approved vaccines.
Schedule:**
Day 0: First dose + HRIG (if indicated)
Days 3, 7, 14 (and 28 if immunocompromised): Subsequent doses IM
Route:** Intramuscular, preferably in the deltoid (not gluteal).

4. Management of Category I, II, III Exposures
| Category | Description | Management |
|------------|----------------|--------------|
| Category I | Touching or feeding animals, licks on intact skin | No PEP needed |
| Category II | Nibbling of uncovered skin, minor scratches | Immediate vaccination; consider RIG if high risk |
| Category III | Transdermal bites, scratches, mucous membrane exposure | Immediate vaccination + RIG |

5. Monitoring & Follow-up
Observe for adverse reactions to vaccines (e.g., allergic reactions).
Reinforce wound care.
Ensure completion of vaccine series.
Educate about avoiding animal contact until complete prophylaxis.

6. Prevention & Public Health
Vaccination of domestic animals.
Control of stray animal populations.
Public education on avoiding bites and seeking prompt medical care.
Mass vaccination campaigns in endemic areas.

References

World Health Organization (WHO). Rabies Fact Sheet. 2018. https://www.who.int/news-room/fact-sh...
Centers for Disease Control and Prevention (CDC). Post-Exposure Prophylaxis for Rabies. https://www.cdc.gov/rabies/medical_ca...
WHO Expert Consultation. Human rabies prophylaxis: WHO position paper. Weekly Epidemiological Record. 2018;93(16):201–220.
Fooks AR, et al. Rabies. Nat Rev Dis Primers. 2017;3:17091.
Kumar & Clark. Clinical Medicine, 10th Edition, Elsevier, 2018.

Summary
Immediate wound cleaning is critical.
PEP with rabies vaccine and RIG is highly effective if administered promptly.
The management depends on the type of exposure.
Prevention includes vaccination of animals and public awareness.

If you'd like detailed dosing schedules, specific management algorithms, or counseling points, just let me know!