Comparing clinical protocols for the treatment of human rabies: the Milwaukee protocol and the Brazilian protocol (Recife)

Abstract

Introduction: Rabies is a major and seriously neglected public health problem worldwide. A treatment consisting of supportive therapy with the use of drugs that show antiviral activity is called the Milwaukee Protocol. In Brazil, this protocol was adapted to the national reality and called the Recife Protocol. In this study, we compared the Milwaukee Protocol with the Recife Protocol, assessing the differences and how these differences may change the course of clinical management. Methods: We searched electronic databases for the use of anti-rabies treatments. A total of 65 articles were published between 2004 and 2019. Results: The protocols have similarities in care related to rabies patients and are important for the treatment of patients in intensive care units. Both protocols indicate deep sedation, antiviral use, constant concern with electrolyte balance, and vasoconstriction related to the condition. Many differences were observed in this study. For the Milwaukee Protocol, sedation should be gradually removed after the eighth day, and on the twelfth day, the patient should be without sedation. In the Recife Protocol, in order to avoid immunomodulation, it is recommended to remove sedation according to the titers of neutralizing antibodies to the rabies virus in the cerebral spinal fluid. Conclusions: In addition to the differences and similarities raised, our findings indicate that these protocols require a large center for rabies treatment, but the disease most often occurs in places where resources and hospital infrastructure are scarce.

Human Rabies Treatment—From Palliation to Promise

“…The induction of a therapeutic coma has been attempted in other patients and has been unsuccessful, with at least 53 documented failures [ 25 ]. The Recife protocol, first implemented in Brazil, is derived from the Milwaukee protocol but similarly failed to demonstrate a survival benefit [ 33 ]. Various adaptations and revisions will likely continue.…”

Atenção Primária À Saúde: Promoção, Prevenção, Diagnóstico E Implementação De Cuidados

“…Ainda que haja grande potencial, permanece uma questão em aberto a definição de quem é responsável por resultados imprecisos ou prejudiciais gerados pela tecnologia (CARRASCO, 2023;LEMES;LEMOS, 2020).…”

Rabies, the cause of fatal encephalitis

“…The WHO, the World Organization for Animal Health (OAH), the Food and Agricultural Organization of the United Nations (FAO), and the Global Alliance for Rabies Control (GARC), have established a global multisectoral framework that is "united against rabies", in order to provide a common strategy and to achieve "zero human deaths from dog-mediated rabies by 2030". 16 Until now, no standardized medical treatment has existed, in our patient, from the moment of the suspected infection, management was established according to the guidelines of the Milwaukee protocol, 17 which it was possible to save an infected patient for the first time, and consists of inducing a coma and treat with antiviral medications, in order to reach maturation of the primary immune response of the patient. In addition, 20 units per kilogram of Gamma-Globulins and a single dose of Vero-cell rabies vaccine were administered.…”