title: Failure of therapeutic coma and ketamine for therapy of human rabies.
abstract: The recent success in treating a human rabies patient in Milwaukee prompted the use of a similar therapeutic approach in a 33-year-old male Thai patient who was admitted in the early stages of furious rabies. He received therapeutic coma with intravenous diazepam and sodium thiopental to maintain an electroencephalographic burst suppression pattern, which was maintained for a period of 46 h, as well as intravenous ketamine (48 mg/kg/day) as a continuous infusion and ribavirin (48 to 128 mg/kg/day) via a nasogastric tube. He never developed rabies virus antibodies and he died on his 8th hospital day. At least three other patients have been treated unsuccessfully with a similar therapeutic approach. Because of the lack of a clear scientific rationale, high associated costs, and potential complications of therapeutic coma, the authors recommend caution in taking this approach for the therapy of rabies outside the setting of a clinical trial. More experimental work is also needed in cell culture systems and in animal models of rabies in order to develop effective therapy for human rabies.
authors.affiliation: Division of Neurology, Chulalongkorn University Hospital, Bangkok, Thailand.
authors.forename: Thiravat
authors.initials: T
authors.lastname: Hemachudha
authors.forename: Buncha
authors.initials: B
authors.lastname: Sunsaneewitayakul
authors.forename: Tayard
authors.initials: T
authors.lastname: Desudchit
authors.forename: Chusana
authors.initials: C
authors.lastname: Suankratay
authors.forename: Chanchai
authors.initials: C
authors.lastname: Sittipunt
authors.forename: Supaporn
authors.initials: S
authors.lastname: Wacharapluesadee
authors.forename: Pkamatz
authors.initials: P
authors.lastname: Khawplod
authors.forename: Henry
authors.initials: H
authors.lastname: Wilde
authors.forename: Alan C
authors.initials: AC
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000818:Animals; D001921:Brain / Q000821:virology; D003128:Coma / Q000139:chemically induced*; D004195:Disease Models, Animal; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D011818:Rabies / Q000628:therapy*; D011820:Rabies virus / Q000302:isolation & purification; D013116:Spinal Cord / Q000821:virology; D017211:Treatment Failure
chemical_list: D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine