The standard prophylactic therapy includes injecting part of the immunoglobulin dose at the site of the animal bite. Suwansrinon et al identified a number of complications associated with making these injections. The authors are from Queen Saovabha Memorial Institute in Bangkok, Thailand.


Sites posing problems for proper care:

(1) finger and toes

(2) external genitalia (penis, scrotum, labia)

(3) facial structures (eyelid, nose, tongue and ear)


Potential complications at the injection sites:

(1) compartment syndrome if space available for expansion is limited and too much immunoglobulin is injected

(2) pain, especially around a fingernail or toenail

(3) secondary infection

(4) allergic reaction to vaccine component


The risk of treatment failure is increased if:

(1) insufficient immunoglobulin is injected

(2) injection of immunoglobulin is delayed

(3) the wound is sutured early. Suturing is delayed whenever possible.

(4) direct inoculation into a nerve


Problems associated with local injection are minimized when done by a well-trained and experienced staff.


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