Dose of antivenom for the treatment of snakebite with neurotoxic envenoming: Evidence from a randomised controlled trial in Nepal

PLoS Neglected Tropical Diseases
Emilie AlirolFrançois Chappuis

Abstract

Currently, there is inadequate evidence on which to base clinical management of neurotoxic snakebite envenoming, especially in the choice of initial antivenom dosage. This randomised controlled trial compared the effectiveness and safety of high versus low initial antivenom dosage in victims of neurotoxic envenoming. This was a balanced, randomised, double-blind trial that was conducted in three health care centers located in the Terai plains of Nepal. Participants received either low (two vials) or high (10 vials) initial dosage of Indian polyvalent antivenom. The primary composite outcome consisted of death, the need for assisted ventilation and worsening/recurrence of neurotoxicity. Hourly evaluations followed antivenom treatment. Between April 2011 and October 2012, 157 snakebite victims were enrolled, of which 154 were analysed (76 in the low and 78 in the high initial dose group). Sixty-seven (43·5%) participants met the primary outcome definition. The proportions were similar in the low (37 or 48.7%) vs. high (30 or 38.5%) initial dose group (difference = 10·2%, 95%CI [-6·7 to 27·1], p = 0·264). The mean number of vials used was similar between treatment groups. Overall, patients bitten by kraits did worse than those bit...Continue Reading

References

Jan 1, 1991·Toxicon : Official Journal of the International Society on Toxinology·R D Theakston, D A Warrell
Feb 1, 1997·Wilderness & Environmental Medicine·C PochanugoolH Wilde
Feb 5, 2003·Toxicon : Official Journal of the International Society on Toxinology·Sanjib Kumar SharmaShekhar Koirala
Feb 27, 2003·Journal of Environmental Science and Health. Part. B, Pesticides, Food Contaminants, and Agricultural Wastes·S B ShahD K Bhumbla
Mar 14, 2003·Accident and Emergency Nursing·Carmel J Stewart
Jul 6, 2004·Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine·He ZhuYi Wang
Sep 28, 2007·Wilderness & Environmental Medicine·Ian D Simpson, Robert L Norris
Apr 23, 2014·Biomolecules & Therapeutics·Pushpa Saranya KolliparaJin Tae Hong
Aug 12, 2014·Bulletin of the World Health Organization·José María GutiérrezUNKNOWN Global Snakebite Initiative
Jul 22, 2015·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Rashmi Ranjan DasNishanth Dev
Mar 15, 2016·The Journal of Dermatology·Yuichiro YoshinoUNKNOWN Wound/Burn Guidelines Committee

❮ Previous
Next ❯

Citations

Jan 24, 2019·BMJ : British Medical Journal·Ravikar RalphUlrich Kuch
Jun 18, 2019·Journal of Tropical Medicine·Sanjib Kumar SharmaWalter Robert John Taylor
Aug 9, 2020·Frontiers in Bioengineering and Biotechnology·Timothy Patrick Jenkins, Andreas Hougaard Laustsen
Aug 26, 2021·Toxicon: X·Muhammad HamzaAbdulrazaq G Habib
Sep 3, 2021·Toxicon : Official Journal of the International Society on Toxinology·Siddharth BhatiaKarthikeyan Vasudevan
Nov 1, 2020·Toxicon : Official Journal of the International Society on Toxinology·Ashis K Mukherjee

❮ Previous
Next ❯

Clinical Trials Mentioned

NCT01284855

Software Mentioned

R
R foundation for

Related Concepts

Related Feeds

Anaphylaxis

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death.

Related Papers

Toxicon : Official Journal of the International Society on Toxinology
Chhabilal T MagarDeb Prasad Pandey
Toxicon : Official Journal of the International Society on Toxinology
Sanjib Kumar SharmaShekhar Koirala
© 2022 Meta ULC. All rights reserved