Therapy of human rabies.

Preventive therapy for rabies, including wound cleansing and active and passive immunization after a recognized exposure, is highly efficacious. Unfortunately, there is no established therapy that is effective for patients who develop rabies encephalomyelitis. There have been several survivors from rabies and all but one received rabies vaccine prior to the onset of clinical illness. Aggressive approaches to therapy of human rabies may be appropriate in certain situations. There is no scientific rationale for the use of therapeutic coma, and there are many reports of failures using this approach. Therapeutic coma should be abandoned for the therapy of rabies. New approaches such as therapeutic hypothermia should be evaluated, in combination with other therapeutic agents. More basic research is needed on the mechanisms involved in rabies pathogenesis, which will hopefully facilitate the development of new therapeutic approaches in the future for this ancient disease.