Context Rabies postexposure prophylaxis (RPEP) treatments and associated co
sts have increased in the United States. The extent to which RPEP use is co
nsistent with guidelines is not well understood.
Objective To characterize animal contacts and determine the frequency and f
actors associated with inappropriate RPEP use.
Design, Setting, and Patients Prospective case series study of patients pre
senting with an animal exposure-related complaint from July 1996 to Septemb
er 1998 at 11 university-affiliated, urban emergency departments (the Emerg
ency ID Net).
Main Outcome Measures Exposure type, circumstances, and RPEP use (appropria
teness defined by local public health departments).
Results Of 2030 exposures, 1635 (81%) were to dogs; 268 (13%) to cats; 88 (
4%) to rodents/rabbits; 70 (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 d
og (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 consider
ed appropriate in 1857 exposures (91.5%), Use of RPEP was considered inappr
opriate in 54 cases (40% of those in which it was given), owing to factors
including animal availability for observation and exposure in a low-endemic
ity area. Rabies postexposure prophylaxis was considered inappropriately wi
thheld from 119 cases (6.3% of those not receiving RPEP), often because a d
omestic animal was unavailable for observation or testing.
Conclusion These results suggest that use of RPEP is often inappropriate. G
reater compliance with current guidelines would increase RPEP use. Physicia
n education, improved coordination with public health officials, and clarif
ication of RPEP guidelines could optimize use of this expensive resource.