The Milwaukee protocol has been attributed to survival in rabies encephalitis 
despite a lack of scientific evidence supporting its therapeutic measures. We 
have reviewed the literature with reference to specific treatment 
recommendations made within the protocol. Current literature fails to support an 
important role for excitotoxicity and cerebral vasospasm in rabies encephalitis. 
Therapies suggested in the Milwaukee protocol include therapeutic coma, ketamine 
infusion, amantadine, and the screening/prophylaxis/management of cerebral 
vasospasm. None of these therapies can be substantiated in rabies or other forms 
of acute viral encephalitis. Serious concerns over the current protocol 
recommendations are warranted. The recommendations made by the Milwaukee 
protocol warrant serious reconsideration before any future use of this failed 
protocol.