Rabies postexposure prophylaxis (RPEP) treatments and associated costs
have increased in the United States. The extent to which RPEP use is consistent
with guidelines is not well understood.
To characterize animal contacts and determine the frequency and factors
associated with inappropriate RPEP use.
Design, Setting, and Patients
Prospective case series study of patients presenting with an animal
exposure–related complaint from July 1996 to September 1998 at 11 university-affiliated,
urban emergency departments (the Emergency ID Net).
Main Outcome Measures
Exposure type, circumstances, and RPEP use (appropriateness defined
by local public health departments).
Of 2030 exposures, 1635 (81%) were to dogs; 268 (13%) to cats; 88 (4%)
to rodents/rabbits; 10 (0.5%) to raccoons; 5 (0.2%) to bats; and 24 (1.2%)
to other animals. Among those exposed, 136 (6.7%) received RPEP after dog
(95), cat (21), raccoon (8), bat (4), or other animal (8) exposures. Use of
RPEP varied by site (range, 0%-27.7% of exposures), with most frequent use
reported at sites in the eastern United States. Management was considered
appropriate in 1857 exposures (91.5%). Use of RPEP was considered inappropriate
in 54 cases (40% of those in which it was given), owing to factors including
animal availability for observation and exposure in a low-endemicity area.
Rabies postexposure prophylaxis was considered inappropriately withheld from
119 cases (6.3% of those not receiving RPEP), often because a domestic animal
was unavailable for observation or testing.
These results suggest that use of RPEP is often inappropriate. Greater
compliance with current guidelines would increase RPEP use. Physician education,
improved coordination with public health officials, and clarification of RPEP
guidelines could optimize use of this expensive resource.