Rabies immunoglobulin

How it works

It supplies ready-made neutralising antibodies that bind and inactivate rabies virus at the wound site during the interval before an active immune response to vaccine develops.

Prescribing in practice

• As much of the dose as possible should be infiltrated into and around the wound, with any remainder given intramuscularly at a site distant from the vaccine to avoid neutralising the vaccine response.
• It is given together with, but never mixed in the same syringe as, rabies vaccine as part of post-exposure prophylaxis.
• It is indicated only for unimmunised (or incompletely immunised) people with a significant exposure; those previously fully vaccinated need vaccine boosters rather than immunoglobulin, as advised by specialist services.

Monitoring

Observe for immediate hypersensitivity reactions after administration; no routine laboratory monitoring is required.

Counselling the patient

• This injection gives immediate protection while the vaccine course builds your own immunity.
• Thorough wound cleaning and completing the full vaccine schedule are essential.
• Seek urgent specialist advice without delay after any possible rabies exposure.

Evidence & guidelines

Combined rabies immunoglobulin and vaccine for post-exposure prophylaxis is recommended by WHO and UK Health Security Agency guidance for high-risk exposures.