Henry Wilde.
Failures of post-exposure Rabies prophylaxis.
Infect Dis J Jan ;16(3):65-8.

This is an uncomfortable topic which has received little attention at rabies conferences or in recent literature. However, each rabies post exposure prophylaxis (PEP) failure case may contain lessons that might be able to prevent new ones. Chulalongkorn University and the Thai Red Cross Society have had a long standing interest in rabies PEP failures but almost all that came to our earlier attention contained obvious defects in care. It was in 1996 that we encountered the first case where all WHO recommendations had been carefully followed by experienced staff and yet the patient died of rabies . This is why this series of seven cases, of what appeared to be true PEP failures, are being presented. Each of these seven cases had what appeared excellent and prompt wound care, were administered immunoglobulin of equine (ERIG) or human (HRIG) origin at 40 IU/Kg or 20 IU/Kg respectively, and this was injected into and around the bite wounds. Six additional PEP failures with defects in management are also shown to demonstrate that much more educational efforts are needed to prevent more deaths.

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