Should Favipiravir be Used as an Additional Drug in Case of Severe Animal Bites on the Face Especially into the Eyes/ Lips or Aerosol Exposure to Rabies Virus to Prevent Rabies PEP Failures?

Rabies is a zoonotic viral disease that affects the central nervous system leading to respiratory or cardiac failure. Dogs are a major source of rabies infection in human beings. Rabies is 100% fatal but largely preventable if proper and timely Post-Exposure Prophylaxis (PEP) is availed in the form of immediate wound wash with soap and water and injections of vaccine and rabies immunoglobulins, the first week being the most important. Here we describe four cases of PEP failure despite complete prophylaxis with vaccine and Rabies Immunoglobulins (RIG) over the past year in Himachal Pradesh. All failures were due to suspected rabid dog bites on the face, especially on cheeks, lips, or eyes where complete infiltration of RIG may not have been possible leading to PEP failure. We, after extensive research and discussion, are of the opinion that in such situations, we may add another viricidal oral drug favipiravir along with rabies PEP that could help prevent PEP failures in situations where complete RIG infiltration into wounds is difficult to achieve.