Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms
Objective: To compare the efficacy and safety of three polyspecific antivenoms for bites from pit vipers. Design: Randomised double blind comparative trial of three antivenoms. Setting: Shell, Pastaza, southeastern Ecuador. Participants: 210 patients with incoagulable blood were recruited from 221 c...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Published: |
2004
|
| _version_ | 1797074179819831296 |
|---|---|
| author | Smalligan, R Cole, J Brito, N Laing, G Mertz, B Manock, S Maudlin, J Quist, B Holland, G Nelson, S Lalloo, D Rivadeneira, G Barragan, M Dolley, D Eddleston, M Warrell, D Theakston, R |
| author_facet | Smalligan, R Cole, J Brito, N Laing, G Mertz, B Manock, S Maudlin, J Quist, B Holland, G Nelson, S Lalloo, D Rivadeneira, G Barragan, M Dolley, D Eddleston, M Warrell, D Theakston, R |
| author_sort | Smalligan, R |
| collection | OXFORD |
| description | Objective: To compare the efficacy and safety of three polyspecific antivenoms for bites from pit vipers. Design: Randomised double blind comparative trial of three antivenoms. Setting: Shell, Pastaza, southeastern Ecuador. Participants: 210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001. Intervention: One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms. Main outcome measures: Permanent restoration of blood coagulability after 6 and 24 hours. Results: The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by Bothrops atrox, 68 (36%) by B bilineatus, and 10 (5%) by B taeniatus, B brazili, or Lachesis muta. Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in > 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), < 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of < 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P < 0.0001) but only three reactions were severe and none was fatal. Conclusions: All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern. |
| first_indexed | 2024-03-06T23:32:35Z |
| format | Journal article |
| id | oxford-uuid:6c9227e4-b82c-4865-bad0-ce2f20c82b58 |
| institution | University of Oxford |
| last_indexed | 2024-03-06T23:32:35Z |
| publishDate | 2004 |
| record_format | dspace |
| spelling | oxford-uuid:6c9227e4-b82c-4865-bad0-ce2f20c82b582022-03-26T19:11:45ZCrotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenomsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6c9227e4-b82c-4865-bad0-ce2f20c82b58Symplectic Elements at Oxford2004Smalligan, RCole, JBrito, NLaing, GMertz, BManock, SMaudlin, JQuist, BHolland, GNelson, SLalloo, DRivadeneira, GBarragan, MDolley, DEddleston, MWarrell, DTheakston, RObjective: To compare the efficacy and safety of three polyspecific antivenoms for bites from pit vipers. Design: Randomised double blind comparative trial of three antivenoms. Setting: Shell, Pastaza, southeastern Ecuador. Participants: 210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001. Intervention: One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms. Main outcome measures: Permanent restoration of blood coagulability after 6 and 24 hours. Results: The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by Bothrops atrox, 68 (36%) by B bilineatus, and 10 (5%) by B taeniatus, B brazili, or Lachesis muta. Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in > 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), < 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of < 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P < 0.0001) but only three reactions were severe and none was fatal. Conclusions: All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern. |
| spellingShingle | Smalligan, R Cole, J Brito, N Laing, G Mertz, B Manock, S Maudlin, J Quist, B Holland, G Nelson, S Lalloo, D Rivadeneira, G Barragan, M Dolley, D Eddleston, M Warrell, D Theakston, R Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms |
| title | Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms |
| title_full | Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms |
| title_fullStr | Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms |
| title_full_unstemmed | Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms |
| title_short | Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms |
| title_sort | crotaline snake bite in the ecuadorian amazon randomised double blind comparative trial of three south american polyspecific antivenoms |
| work_keys_str_mv | AT smalliganr crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT colej crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT briton crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT laingg crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT mertzb crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT manocks crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT maudlinj crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT quistb crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT hollandg crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT nelsons crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT lallood crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT rivadeneirag crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT barraganm crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT dolleyd crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT eddlestonm crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT warrelld crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms AT theakstonr crotalinesnakebiteintheecuadorianamazonrandomiseddoubleblindcomparativetrialofthreesouthamericanpolyspecificantivenoms |