Beyond the Bite: Clinical Decision-Making for Infection and Rabies Risk in Pregnancy

Authors

• Jesse McAllister, University of LynchburgFollow

Specialty

Primary Care

Abstract

Animal bites during pregnancy present a unique clinical challenge that requires timely, evidence-based decision-making to protect both maternal and fetal health. This case highlights the clinical hesitation that can arise when providers encounter rare but time-sensitive infectious exposures in pregnancy and underscores the need to strengthen provider confidence through clear guidance. Cat bites carry a high risk of infection, most commonly with Pasteurella multocida, and pregnancy-associated immune modulation further reinforces the importance of early, targeted antimicrobial therapy. Amoxicillin-clavulanate, considered safe during pregnancy, was selected as first-line prophylaxis. Because the cat was a stray and unavailable for quarantine, rabies exposure was also a significant concern. Despite limited representation of pregnant patients in rabies research, available evidence supports the safety of both rabies vaccine and human rabies immune globulin during pregnancy. Rabies post-exposure prophylaxis was promptly initiated in accordance with CDC and ACIP recommendations. This case illustrates the complexity of managing zoonotic injuries during pregnancy and emphasizes the importance of rapid risk assessment, pregnancy-appropriate antimicrobial selection, and timely initiation of rabies post-exposure prophylaxis when indicated. Collectively, these factors highlight the need for clear, evidence-based clinical guidance to support confident decision-making and ensure safe care for pregnant patients facing potential infectious exposures.

Recommended Citation

McAllister J. Beyond the Bite: Clinical Decision-Making for Infection and Rabies Risk in Pregnancy. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).