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: Thiravat Hemachudha, Buncha Sunsaneewitayakul, Tayard Desudchit, Chusana Suankratay, Chanchai Sittipunt, Supaporn Wacharapluesadee, Pkamatz Khawplod, Henry Wilde, Alan C Jackson
• Journal: Journal of neurovirology (J Neurovirol) Vol. 12 Issue 5 Pg. 407-9 (Oct 2006) ISSN: 1355-0284 [Print] United States
• PMID: 17065135 (Publication Type: Case Reports, Journal Article)

Chemical References

• Excitatory Amino Acid Antagonists
• Ketamine

Topics

• Adult
• Animals
• Brain (virology)
• Coma (chemically induced)
• Disease Models, Animal
• Excitatory Amino Acid Antagonists (therapeutic use)
• Fatal Outcome
• Humans
• Ketamine (therapeutic use)
• Male
• Rabies (therapy)
• Rabies virus (isolation & purification)
• Spinal Cord (virology)
• Treatment Failure