The Efficacy of Antivenin Latrodectus (Black Widow) Equine Immune F(abʹ)2 Versus Placebo in the Treatment of Latrodectism: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial

Dart, Richard C.; Bush, Sean P.; Heard, Kennon; Arnold, Thomas C.; Sutter, Mark E.; Campagne, Danielle; Holstege, Christopher P.; Seifert, Steven A.; Lo, Jean; Quan, Dan; Borron, Stephen; Meurer, David; Burnham, Randy I.; McNally, Jude; García-Ubbelohde, Walter; Anderson, Victoria E.

doi:10.1016/j.annemergmed.2019.02.007

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…6,7 Of note, in black widow spider (Latrodectus mactans) envenomation, antivenom effectiveness for pain reduction has also been acknowledged in both retrospective reviews and prospective randomised controlled trials. 11,12 RAVE-II examined resolution of systemic features of envenoming as a secondary outcome and found no statistically significant benefit of RBAV over placebo. 2 In our study, by 2 h post RBAV, systemic features resolved in 50% of patients, irritability resolved in 66% and by discharge, 95% had no symptoms.…”

Section: Discussionmentioning

confidence: 99%

Redback spider bites in children in South Australia: A 10‐year review of antivenom effectiveness

Cocks

Chu

Gamage

et al. 2021

Emerg Medicine Australasia

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Objective: To describe the South Australian paediatric redback spider bite experience and to examine the hypothesis that redback antivenom (RBAV) treatment in children is clinically effective. Methods: Retrospective chart review of all children under 18 years of age presenting to the EDs of the three major paediatric or mixed hospitals in Adelaide, South Australia, with a discharge diagnosis of redback spider envenomation between 1 January 2010 and 31 March 2020. The main outcome measures include: patient and bite demographics; presenting symptoms and signs; treatment provided; clinical effects at 2 h post RBAV administration on pain, diaphoresis, blood pressure, heart rate and systemic features; overall clinical impression of RBAV effectiveness and resolution of symptoms prior to discharge. Results: There were 256 patient encounters involving 235 patients. Latrodectism was described in onethird (34%) of the cases. Sixty-one patients received RBAV and in 57 (93%) patients the RBAV had good clinical effect. Two hours post RBAV administration, pain resolved in 71%, hypertension resolved in 62%, diaphoresis resolved in 43% and tachycardia resolved in 82%. There were no cases of urticaria or anaphylaxis and one case of serum sickness. Conclusions: This retrospective review of redback spider envenomation in South Australian children over a 10-year period has demonstrated clinical effectiveness of RBAV in paediatric patients across all age groups, observed in both clinician perceived results and measurable outcomes. RBAV remains an effective treatment for redback envenomation in children.

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Section: Discussionmentioning

confidence: 99%

Redback spider bites in children in South Australia: A 10‐year review of antivenom effectiveness

Cocks

Chu

Gamage

et al. 2021

Emerg Medicine Australasia

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“… 131 Treatment historically consisted of calcium derivates geared to relax muscle, which have since shown to be ineffective. 132 , 133 A combination of antibody-derived antivenom is now the preferred treatment, although one major study showed a significant reduction in pain for 48 hours using antivenom, 133 whereas another major study showed no improvement in pain. 134 Moreover, there seems to be no difference between administering the antivenom intravenously (IV) or intramuscularly (IM), 132 but the literature is sparse.…”

Section: Methodsmentioning

confidence: 99%

Practical Review of the Management of Animal Bites

Savu

Schoenbrunner

Politi

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. Methods: A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. Results: The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. Conclusions: Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.

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“…The largest examined the effectiveness of RBSAV. [8][9][10] These studies reported no significant improvement in pain or systemic effects of envenoming with antivenom. A systematic review of treatments for latrodectism pooled data from these placebo-controlled clinical trials and found that, at best, antivenom is a moderate analgesic, with a number needed to treat of 5 to improve pain.…”

Section: Introductionmentioning

confidence: 93%

Evolution in the choice of therapies used to treat latrodectism: Redback spider antivenom or standard analgesic medications. Nothing to rave about

Sulaeman

Graudins

2023

Emerg Medicine Australasia

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Objectives: Redback spider (RBS) antivenom (RBSAV) use appears to have decreased since the results of the RAVE-2 antivenom efficacy study were released. The aims of this study were to assess change in RBSAV use over time and compare responses to treatment for antivenom and other analgesics. Methods: Retrospective audit of RBS bite referrals to a toxicology unit, from January 2010 to January 2022. Data included demographics, pain severity, treatment (analgesia or RBSAV), response to treatment, representation rate, adverse events, change in antivenom use over time. Results: Of 270 presentations, 157 with moderate or severe pain were included (RBSAV n = 51, analgesia n = 106). Median age was 39 years, n = 81 (51%) female. Those receiving antivenom were more likely to report severe pain n = 46/51 (84%) versus n = 68/106 (58%) (P = 0.006). Eighty-three percent of antivenom doses were administered between 2010 and 2013. Analgesia-only group received various combinations of paracetamol, NSAIDs, and opioids. In those receiving RBSAV, 17/48 (35%), 26/48 (54%), 5/48 (10%) reported a partial, complete or no reduction in pain, respectively, versus 30/77 (39%), 43/77 (58%) and 4/77 (5%), for analgesia-only group. Post-treatment pain was not recorded in three RBSAV and 28 analgesia-only patients. Pain reduction was no different for intravenous and intramuscular antivenom. Re-presentation for ongoing pain was more common in the analgesia-only group, 16/106 (15%) versus 1/51 (2%) for antivenom (P = 0.013). Conclusion: Antivenom use fell over the study period. There was no difference in pain relief between RBSAV and analgesia-only groups. RBSAV, regardless of route of administration, was no better than standard analgesics in pain reduction in the present study.

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The Efficacy of Antivenin Latrodectus (Black Widow) Equine Immune F(abʹ)2 Versus Placebo in the Treatment of Latrodectism: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial

Cited by 14 publications

References 16 publications

Redback spider bites in children in South Australia: A 10‐year review of antivenom effectiveness

Redback spider bites in children in South Australia: A 10‐year review of antivenom effectiveness

Practical Review of the Management of Animal Bites

Evolution in the choice of therapies used to treat latrodectism: Redback spider antivenom or standard analgesic medications. Nothing to rave about

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