A 19-year-man presents to the emergency department because he is bitten by a stray dog. On physical examination, there is a penetrating wound to the right forearm. The dog is nowhere to be found. The wound is cleaned with water and povidone-iodine solution. Which of the following is the most appropriate next step in management?
Rabies is transmitted through the saliva of infected animals. Once clinical signs develop, the disease is almost 100% fatal. Symptoms of rabies may include apathy, as well as hyperexcitability Finding Negri bodies in nerve cells of the brain in infected animals confirms the diagnosis. Polymerase chain reaction for detection of viral material is another method of confirming the diagnosis. In cats and dogs that are not available for observation (lasting 10 days) to determine if they have signs of rabies, public health authorities should be consulted to determine the potential risk of rabies in the animal based on local rates of rabies in wild animals. Alternatively, if there is a high risk the animal is infected, then postexposure prophylaxis should be started with rabies vaccination on days 0, 3, 7, 14, and 28 as well as one dose of rabies immune globulin on day 0.
start postexposure prophylaxis
contact the local public health professional for further advice
treat with oral doxycycline
treat with IV ceftriaxone
Infection