Demise of the Milwaukee Protocol for Rabies

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• Human rabies is nearly fatal, with few survivors often experiencing severe neurological deficits.
• The Milwaukee protocol, involving induced coma and specific drugs, was proposed after a 2004 survivor but lacks evidence of efficacy.
• Despite aggressive promotion, the protocol has seen at least 64 documented failures over two decades.

Purpose of the Study:

• To evaluate the efficacy of the Milwaukee protocol in treating human rabies.
• To critically assess the evidence supporting the Milwaukee protocol's use.
• To advocate for the abandonment of the Milwaukee protocol and the exploration of novel therapeutic approaches.

Main Methods:

• Review of documented cases of rabies treated with the Milwaukee protocol.
• Analysis of survival rates and neurological sequelae in patients receiving the protocol.
• Comparison of outcomes with historical data and critical care management.

Main Results:

• No subsequent detailed reports have confirmed the efficacy of the Milwaukee protocol since its inception.
• At least 64 cases have documented the failure of the Milwaukee protocol.
• Critical care management, used for decades, is a likely contributor to survival, not the protocol itself.

Conclusions:

• The Milwaukee protocol has failed to demonstrate consistent efficacy in treating human rabies.
• Continued use of the Milwaukee protocol is not supported by scientific evidence.
• New therapeutic strategies informed by rabies pathogenesis are urgently required to improve patient outcomes.