Randomized Comparative Trial of three Monospecific Antivenoms for Bites by the Malayan Pit Viper (Calloselasma rhodostoma) in Southern Thailand: Clinical and Laboratory Correlations

Warrell, D. A.; Looareesuwan, Sornchai; Rd, Theakston; Re, Phillips; Chanthavanich, Pornthep; Viravan, C; Supanaranond, Wichai; Karbwang, Juntra; M, Ho; Ra, Hutton

doi:10.4269/ajtmh.1986.35.1235

Cited by 102 publications

(41 citation statements)

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“…Reactions to antivenom remain common despite improvements in manufacturing processes 2 – 7. Prophylaxis is therefore important 4 8 – 10.…”

Section: Discussionmentioning

confidence: 99%

“…Antivenom (hyperimmune immunoglobulin), the only specific antidote, may cause anaphylactic or anaphylactoid reactions,2 – 5 depending on the type of antivenom, dose, mode of administration, and previous exposure to animal proteins 6. Adverse reactions cannot be predicted by sensitivity tests,7 and the reported frequency is as high as 87% 3.…”

Section: Introductionmentioning

confidence: 99%

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Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites

Fan

Marcopito

Cardoso

et al. 1999

BMJ

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Objective To investigate the efficacy of the H 1 antihistamine promethazine against early anaphylactic reactions to antivenom. Design Sequential randomised, double blind, placebo controlled trial. Setting Public hospital in a venom research institute, São Paulo, Brazil. Participants 101 patients requiring antivenom treatment after being bitten by bothrops snakes. Intervention Intramuscular injection of promethazine (25 mg for adults and 0.5/kg for children) or placebo given 15-20 min before starting intravenous infusion of antivenom. Main outcome measures Incidence and severity of anaphylactic reactions occurring within 24 hours after antivenom. Results Reactions occurred in 12 of 49 patients treated with promethazine (24%) and in 13 of 52 given placebo (25%); most were mild or moderate. Continuous sequential analysis indicated that the study could be interrupted at the 22nd untied pair, without preference for promethazine or placebo. Conclusion Prophylaxis with promethazine does not prevent early reactions. Patients should be observed carefully during antivenom infusion and the subsequent few hours.

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“…Reactions to antivenom remain common despite improvements in manufacturing processes 2 – 7. Prophylaxis is therefore important 4 8 – 10.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites

Fan

Marcopito

Cardoso

et al. 1999

BMJ

View full text Add to dashboard Cite

show abstract

“…The effectiveness of antivenom in treating local toxicity due to viper venoms was equivocal in several clinical trials evaluating systemic effects (7)(8)(9)(10). A retrospective study found that antivenom administration was associated with less severe edema after Vipera Berus envenomation (11).…”

Section: Introductionmentioning

confidence: 97%

Systemic antivenom and skin necrosis after green pit viper bites

Chotenimitkhun

Rojnuckarin

2008

Clinical Toxicology

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“…[18][19][20] Two milliliters of venous blood was placed in a new, clean, dry glass test tube and left undisturbed for 20 min at room temperature. The tube was then tipped to see if the blood was completely liquid (non-clotting) or whether it contained any clot (clotted).…”

Section: Methodsmentioning

confidence: 99%

A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan Russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study.

Ariaratnam¹,

Meyer²,

Perera³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Russell's viper is the most important cause of life-threatening snake bite and acute renal failure in Sri Lanka. Only equine polyspecific antivenoms imported from India are available. They have not proved effective clinically or in clearing venom antigenemia and they frequently cause reactions. In an attempt to reduce mortality and morbidity, a new monospecific ovine Fab fragment antivenom (PolongaTab ; Therapeutic Antibodies, Inc., London, United Kingdom) was raised against Sri Lankan Russell's viper venom. In a preliminary dose-finding study in 35 patients, an initial dose of 3-4 g restored blood coagulability permanently and stopped systemic bleeding, even in severely envenomed patients. Venom antigenemia disappeared within 1 hr of antivenom treatment but recurred, probably as a result of continued absorption of venom from the site of the bite, after the rapid clearance of therapeutic antibody. Twelve patients (34%) experienced early reactions that were usually mild and always responded to epinephrine.

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Randomized Comparative Trial of three Monospecific Antivenoms for Bites by the Malayan Pit Viper (Calloselasma rhodostoma) in Southern Thailand: Clinical and Laboratory Correlations

Cited by 102 publications

References 0 publications

Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites

Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites

Systemic antivenom and skin necrosis after green pit viper bites

A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan Russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study.

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