The efficacy of antivenom in the treatment of bites by the Papuan taipan (Oxyuranus scutellatus canni)

Abstract

A prospective series of 156 patients systemically envenomed following the bite of a Papuan taipan (Oxyuranus scutellatus canni) were studied. All patients were treated with appropriate antivenom and clinical course and outcome were compared. The proportion of patients requiring intubation was significantly smaller, and the time to resolution of neurotoxicity and discharge from hospital significantly shorter, in patients receiving antivenom no more than 4 h after the bite. No significant difference in outcome was demonstrated between patients receiving antivenom at various times after 4 h. No difference was demonstrated in the times to restoration of coagulability between the 2 groups. The only significant difference between a small number of patients given 2 vials of antivenom and patients given a single vial at the same time after envenoming was a marginally shorter duration of intubation in those who required it. The study suggests that, to achieve significant clinical benefit in Papuan taipan bite, antivenom must be given as early as possible.

Antivenom for Neuromuscular Paralysis Resulting From Snake Envenoming

“…The search also yielded numerous cohort studies that discussed the effects of antivenom on neuromuscular paralysis, including studies on envenoming by elapids such as Indian krait ( Bungarus caeruleus ) [4,18,87,88], multi-banded krait ( B. multicinctus ) [48,89], Malayan krait ( B. candidus ) [48,90], common cobra ( Naja naja ) [8,21], monocellate cobra ( N. kaouthia ) [91,92,93,94], Philippine cobra ( N. philippinensis ) [7], eastern coral snake ( Micrurus fulvius fulvius ) [95], coastal taipan ( Oxyuranus scutellatus ) [96], Papuan taipan ( O. canni ) [10,97,98], tiger snake ( Notechis scutatus ) [11,99], rough-scaled snake ( Tropidechis carinatus ) [100], Papuan death adder ( Acanthophis laevis ) [101], Australian death adders ( Acanthophis sp.) [12], Papuan black snake ( Pseudechis papuanus ) [102], and viperids such as Sri Lankan Russell’s viper ( Daboia russelii ) [5,103,104,105], Balken adder ( Viper berus bosniensis ) [17], southern tropical rattlesnake ( Crotalus durissus terrificus ) [106,107] and Mojave rattlesnake ( C. scutulatus scutulatus ) [108] and North American crotalids [109].…”

“…However, apart from seven studies [4,5,11,12,97,100,103], the remaining studies had no data on serial venom antigen concentrations to enable comment on the ability of antivenom to clear free venom (efficacy). This deficiency, together with a lack of serial, well-defined objective neurological or neurophysiological parameters, makes it difficult to interpret the findings of the vast majority of the studies on the effectiveness of the antivenom in preventing or reversing paralysis, given that there was no untreated group for comparison.…”

“…In the study of 166 Papuan taipan envenoming, early administration of antivenom prevented intubation, with only 13.3% requiring intubation in patients given antivenom <4 h post-bite, compared to 63% in patients receiving antivenom >4 h post-bite [98]. Another study of 156 taipan envenomings also found that antivenom given within 4 h resulted in less patients requiring intubation [97]. A more recent cohort study in Australia of 40 coastal taipan ( Oxyuranus spp.)…”

Neurotoxins From Australo-Papuan Elapids: A Biochemical and Pharmacological Perspective

“…This may indicate that antivenom can effectively bind these presynaptic neurotoxins, hence the importance of prompt administration of antivenom following envenoming by snakes known to posses these toxins. This is clearly reflected in severe cases of envenoming by the Papuan taipan requiring prolonged periods of mechanical ventilation (Currie, 2000;Lalloo et al, 1995;Trevett et al, 1995).…”

232. Death Adder Envenoming Causes Neurotoxicity not Reversed by Antivenom - Australian Snakebite Project (ASP-16)

“…Previously reported possible effectiveness of anticholinesterates [27,[32][33][34] was not supported by this study, with the use of neostigmine providing little benefit in four cases. Given that neurotoxicity did not appear to resolve or reverse with the use of antivenom or anticholinesterases it is most likely to be due to irreversible injury from presynaptic neurotoxins, similar to the neurotoxicity from other Australian elapids such as the taipan [2,35]. Although it is possible that antivenom prevented those with mild neurotoxicity from getting progressively worse, this only occurred in one patient (Table 3, Row 4) and the two patients with severe neurotoxicity received antivenom within 6 hours ( Table 3).…”