Title: Demise of the Milwaukee Protocol for Rabies
Author: Alan C. Jackson, MD, Institute of Neurology – Queen Square, University College London, UK
Source: Clinical Infectious Diseases (Advance online publication, March 26, 2025; Article ID: ciaf157) (bmcinfectdis.biomedcentral.com).
Citation: Alan C Jackson, Demise of the Milwaukee Protocol for Rabies, Clinical Infectious Diseases, 2025;, ciaf157, https://doi.org/10.1093/cid/ciaf157
🔍 Background & Objective
Dr. Jackson presents a critical evaluation of the Milwaukee Protocol, an aggressive treatment originally developed for human rabies cases. The article assesses its historical use, clinical outcomes, and implications for future treatment guidelines, arguing that it has failed to produce consistent success and should be retired in clinical practice (academic.oup.com).
⚠️ Key Findings & Analysis
- Despite initial high hopes, survival rates have not improved significantly with the protocol since its inception.
- The risks associated with the protocol—including prolonged ICU stays, high costs, and adverse neurological outcomes—have often outweighed potential benefits.
- Dr. Jackson proposes that time and resources should be redirected toward novel therapeutic approaches, such as antiviral agents and immunomodulatory strategies, based on evolving knowledge of rabies pathophysiology .
🧭 Clinical Implications
- The article recommends abandoning the Milwaukee Protocol in favor of empirically grounded therapies.
- Advocates for intensified development of evidence-based therapies and supportive care protocols, highlighting the need for controlled trials and global collaboration.
📌 Conclusion
Alan C. Jackson concludes that the time has come to officially retire the Milwaukee Protocol for human rabies—emphasizing that focusing on innovative, scientifically robust treatments offers a clearer path to patient improvement and public health progress (academic.oup.com).
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