ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2025
Demise of the Milwaukee Protocol for Rabies.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Fatal rabies in a child.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Article
- Rabies in Europe: Epidemiology, Clinical Management, and Prevention.Deutsches Arzteblatt international · 2026Review
- Combined Glycoprotein Mutations in Rabies Virus Promote Astrocyte Tropism and Protective CNS Immunity in Mice.Viruses · 2026Article
- Working towards a single-dose vaccine for rabies post-exposure prophylaxis.Future virology · 2026Article
- Biological barriers underlying the extremely high fatality of symptomatic rabies: neuroinvasion, immune evasion, and blood-brain barrier restriction.Frontiers in immunology · 2026Review
- Surveillance of Humans Exposed to the Potentially Rabid Animals and Rabies Post-Exposure Prophylaxis in Split-Dalmatia County, Croatia, 2015-2024.Medicina (Kaunas, Lithuania) · 2025Article
- Article
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Abstract
Human rabies has a very high fatality rate and there have only been about 34 well-documented survivors, defined as survival at 6 months after onset of clinical rabies. Many have had serious neurological sequelae. After a young patient survived rabies in Milwaukee in 2004, the approach dubbed the "Milwaukee protocol" has been aggressively promoted as an effective therapy. The protocol has included therapeutic (induced) coma, ketamine, ribavirin, and amantadine and details of the protocol have changed over time. Over the past 2 decades, no subsequent detailed reports have documented evidence of efficacy. There have been at least 64 cases with failure of the protocol. Likely critical care, which has been used for more than 50 years, is an important component of an aggressive approach. The time has now come to abandon the failed Milwaukee protocol for the therapy of rabies and consider new approaches based our current knowledge of rabies pathogenesis.
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Registered trials
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