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Treatment of rabies

Alfred DeMaria, Jr, MD
Section Editors
Martin S Hirsch, MD
Morven S Edwards, MD
Deputy Editor
Jennifer Mitty, MD, MPH


The rabies virus is a single stranded RNA virus that is highly neurotropic, and infects animals and humans. Rabies is one of the oldest and most feared human diseases with the highest case fatality rate of any infectious disease [1]. The clinical illness is characterized by motor weakness, paresthesias, and acute, progressive encephalitis with coma and death [2].

Despite the development of the first rabies vaccine in 1885, the World Health Organization estimates that between 30,000 and 70,000 people die worldwide of rabies each year [3]. Most of these deaths occur in developing countries because of inadequate control of rabies in domesticated animals. In the United States, there has been an average of two to three fatal human cases per year since 1980, mainly related to bat-associated rabies viruses [4-7].

The management of the patient with rabies and the use of experimental therapies/protocols will be reviewed here. The epidemiology, clinical manifestations, diagnosis, and prevention of rabies are discussed elsewhere. (See "Clinical manifestations and diagnosis of rabies" and "Rabies immune globulin and vaccine" and "When to use rabies prophylaxis".)


There is no proven effective therapy for rabies. Thus, preventing human rabies infection through the use of pre-exposure prophylaxis (for high-risk groups) and/or post-exposure prophylaxis remains the cornerstone of management [8,9]. (See "When to use rabies prophylaxis" and "Rabies immune globulin and vaccine".)

For patients with symptomatic rabies, treatment is mostly supportive. However, in rare situations, the use of an aggressive treatment protocol may provide some benefit. (See 'Milwaukee protocol' below.)


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Literature review current through: Apr 2017. | This topic last updated: Mar 21, 2017.
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