From the Guidelines
Steroids are not recommended for the treatment of rhabdomyolysis or rabies, as they may worsen outcomes by suppressing the immune response needed to fight the virus in rabies and have no established benefit in rhabdomyolysis. For rhabdomyolysis, the primary treatment involves aggressive intravenous fluid administration (usually normal saline) to maintain urine output and prevent kidney damage, along with addressing the underlying cause. Medications like sodium bicarbonate may be used in certain cases to alkalinize the urine. For rabies, treatment consists of wound cleansing, rabies immune globulin, and a series of rabies vaccinations (post-exposure prophylaxis) as recommended by the Advisory Committee on Immunization Practices 1. Once clinical symptoms of rabies appear, a protocol called the Milwaukee Protocol might be attempted, which involves induced coma and antiviral medications, though its effectiveness remains controversial. Some studies have explored the use of various adjunctive agents in viral encephalitis, including corticosteroids, but their use is not recommended for rabies and is generally not supported by strong evidence for other conditions like encephalitis 1. In fact, the use of high doses of steroids has been mentioned in the context of experimental treatments for rabies, but it is not a recommended or standard treatment component due to concerns about worsening outcomes 1. Therefore, the focus should remain on established treatments that prioritize morbidity, mortality, and quality of life outcomes.
From the Research
Rhabdomyolysis Treatment
- The treatment of rhabdomyolysis typically involves aggressive intravenous fluid resuscitation (IVFR) to prevent acute renal failure and improve outcomes 2, 3, 4, 5.
- There is no evidence to support the routine use of bicarbonate-containing fluids, mannitol, and loop diuretics in the treatment of rhabdomyolysis 2, 4.
- Steroids may be used in certain cases, such as in combination with aggressive fluid management and prone positioning, as seen in a case of trauma and COVID-induced rhabdomyolysis 6.
Rabies Treatment
- There is no mention of steroids being used to treat rabies in the provided studies.
- The provided studies focus on the treatment of rhabdomyolysis, and do not discuss the treatment of rabies.
Key Findings
- Aggressive IVFR is conditionally recommended to improve outcomes of acute renal failure and lessen the need for dialysis in patients with rhabdomyolysis 2.
- The quality of evidence for the treatment of rhabdomyolysis is deemed to be very low, with the vast majority of the literature being retrospective studies 2.
- Early and aggressive fluid resuscitation is agreed on as the main intervention for preventing and treating acute kidney injury in rhabdomyolysis 4.