Treatments to avoid in rabies

 Q: 38 years old male is admitted to ICU with a history of exposure to bats and clinical symptoms pertinent to rabies. The patient required intubation due to progressive agitation and aerophobia. Which treatment modalities should be AVOIDED in patients with high suspicion of rabies?

Answer: In general there are no specific treatments for rabies. Most of the treatment is supportive though some antiviral, immunotherapies, cooling helmet, or nasal cooling has been described. The following treatments should be avoided in rabies as they can make symptoms worse or may harm the patient.

• Corticosteroids: May prevent the immune response required for viral clearance. 
• Minocycline: Described in literature but showed a harmful effect 
• Therapeutic coma: It requires paralytic which should be avoided as much as possible in rabies. 
•  Prophylaxis of cerebral vasospasm like nimodipine or Vitamin C: Vasospasm does not play a role in rabies

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References:

1. Jackson AC, Fu ZF. Pathogenesis. In: Rabies: Scientific Basis of the Disease and its Management, 3, Jackson AC (Ed), Elsevier Academic Press, Oxford 2013. p.299. 

2. Enright JB, Franti CE, Frye FL, Behymer DE. The effects of corticosteroids on rabies in mice. Can J Microbiol 1970; 16:667. 

3. Jackson AC, Scott CA, Owen J, et al. Therapy with minocycline aggravates experimental rabies in mice. J Virol 2007; 81:6248. 

4. Rossiter JP, Jackson AC. Pathology. In: Rabies: Scientific Basis of the Disease and its Management, 3, Jackson AC (Ed), Elsevier Academic Press, Oxford 2013. p.351.