Step 1 — Select Wound Category
Step 2 — Patient Details
Recommended Regimen
| Category | Type of Contact | Examples | ARV | RIG |
|---|---|---|---|---|
| Cat I | Touching/feeding animals. Licks on intact skin. | Petting a dog, lick on unbroken skin | None | None |
| Cat II | Nibbling uncovered skin. Minor scratches without bleeding. | Superficial scratch, small nibble not through dermis | Yes — full course | No |
| Cat III | Transdermal bites/scratches with bleeding. Licks on broken skin/mucosa. Bat exposure. | Deep bite, puncture wound, bleeding scratch, saliva on eyes/mouth | Yes — full course | Yes — Day 0 |
Required only for Category III in non-vaccinated patients. Must be given on Day 0 only — cannot be given after Day 7.
| Weight (kg) | HRIG (20 IU/kg) | ERIG (40 IU/kg) |
|---|
Rabies post-exposure prophylaxis (PEP) in India follows the NCDC National Guidelines for Rabies Prophylaxis and the WHO Position Paper 2018. The standard regimen is the Essen intramuscular (IM) 4-dose schedule — a single dose of cell culture vaccine (0.5 mL PVRV or 1.0 mL PCECV) given on Days 0, 3, 7, and 28 in the deltoid. The gluteal region must never be used, as subcutaneous fat at that site impairs vaccine absorption and reduces immunogenicity.
The intradermal (ID) regimen recommended by WHO uses 0.1 mL at two sites on Days 0, 3, and 7 — only three clinic visits and significantly fewer vials per patient, making it the preferred option where trained staff are available. Immunocompromised patients require an additional Day 28 dose even with the ID regimen.
Rabies Immunoglobulin (RIG) is indicated only for Category III wounds in patients not previously vaccinated. The dose is strictly weight-based: HRIG at 20 IU/kg or ERIG at 40 IU/kg. The full dose must be infiltrated around the wound on Day 0 only — it cannot be administered after Day 7. ERIG requires a skin sensitivity test before use and carries a small risk of serum sickness, but remains the more accessible option across government facilities in India.
Wound toilet is the single most important immediate step: wash with soap and running water for at least 15 minutes, followed by application of povidone-iodine. This mechanical flushing alone can reduce rabies virus load at the wound site significantly before any vaccine is given.
Previously vaccinated individuals — those who have completed a full pre- or post-exposure course with a potent cell culture vaccine — require only a 2-dose booster on Day 0 and Day 3. RIG is not needed regardless of wound category. This ARV dose calculator supports all these scenarios, including HRIG vs ERIG selection and IM vs ID route, based on patient weight and clinical history.