Rabies post-exposure prophylaxis in adult patients presenting to the emergency department: A retrospective study

This retrospective cross-sectional study aimed to evaluate the clinical characteristics, risk categorization, and post-exposure prophylaxis (PEP) practices among adult patients who presented to the emergency department due to suspected rabies exposure. A total of 249 patients aged 18 years and older who received at least one dose of rabies vaccine between April 2024 and March 2025 were included. Data regarding demographic features, exposure types, animal characteristics, vaccination status, prophylaxis regimen, and tetanus management were collected and analyzed. The mean age was 33.8 years, and 53.4% of the patients were female. Most exposures (79.9%) involved animals that were either unidentified or had escaped, with cats being the most common species in higher-risk categories. According to national rabies guidelines, patients were classified into exposure categories I–III; no cases met Category IV criteria. While rabies vaccination was appropriately administered in most cases, deviations from guideline recommendations were observed. Notably, some low-risk patients received unnecessary prophylaxis, while rabies immunoglobulin was underutilized in certain high-risk cases. Tetanus prophylaxis was administered to the majority of patients, yet vaccination histories were often undocumented. The findings highlight both strengths and inconsistencies in clinical practice, emphasizing the need for stricter adherence to national rabies management protocols and improved documentation. This study contributes to the growing body of evidence supporting structured, category-based PEP implementation in emergency settings.