Rabies virus, transmitted mainly through animal bites and scratches, causes an almost invariably fatal disease. Guangxi is among the regions of China with a high rabies burden, yet large clinical datasets on exposure patterns and post-exposure prophylaxis (PEP) remain limited. We retrospectively analyzed the records of 19,239 patients with mammal-related injuries treated at the animal injury clinic of the International Zhuang Medicine Hospital Affiliated to Guangxi University of Chinese Medicine from 2020 to 2024. Cats (53.94%) and dogs (39.38%), predominantly owned animals, caused most injuries, and the proportion of cat-related injuries increased from 44.12% in 2020 to 56.66% in 2024 (p for trend < 0.001). Category III exposures accounted for 68.02% of cases, and repeat exposure rose from 7.81% to 18.47% (p for trend < 0.001). Overall, 32.98% of patients presented more than 24 h after injury. Standardized wound management was provided to 71.36% of patients; all patients received rabies vaccination, whereas human rabies immunoglobulin was administered in 44.86% of category III exposures and remained below 47% in every year. Delayed presentation and persistently incomplete passive immunization suggest gaps in PEP delivery. Targeted health education, animal vaccination and management, and standardized wound care and passive immunization may strengthen rabies prevention.