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A randomised controlled trial of two infusion rates to decrease reactions to antivenom.

Geoffrey K Isbister¹, Seyed Shahmy, Fahim Mohamed

¹Discipline of Clinical Pharmacology, University of Newcastle, Newcastle, New South Wales, Australia. geoff.isbister@gmail.com

|June 22, 2012

Summary

This summary is machine-generated.

Slower antivenom infusions do not reduce severe hypersensitivity reactions in snake envenoming patients. Developing higher-quality antivenoms is crucial for improving patient safety and treatment outcomes.

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Area of Science:

Clinical Medicine
Toxicology
Pharmacology

Background:

Snake envenoming is a significant public health issue in Sri Lanka, with high annual bite rates.
Current antivenom treatments are imported and associated with frequent systemic hypersensitivity reactions.
There is a critical need to mitigate adverse reactions to antivenom therapy.

Purpose of the Study:

To evaluate if altering the infusion rate of antivenom impacts the incidence of severe systemic hypersensitivity reactions.
To compare rapid (20-minute) versus slow (2-hour) antivenom infusion protocols in snakebite patients.

Main Methods:

A randomized controlled trial involving non-pregnant adult patients with snake envenoming in Sri Lanka.
Patients received antivenom via either rapid or slow infusion, with allocation concealed.
Severe systemic hypersensitivity reactions were graded using the Brown grading system within four hours of antivenom administration.

Main Results:

No significant difference in the rate of severe systemic hypersensitivity reactions was observed between rapid (32%) and slow (35%) antivenom infusions.
The frequency of mild/moderate hypersensitivity reactions and the need for repeat antivenom doses were similar in both groups.
The study included 104 patients in the rapid infusion arm and 94 in the slow infusion arm.

Conclusions:

Slower antivenom infusion rates do not decrease the high incidence of severe hypersensitivity reactions.
Focus should shift towards developing improved antivenom formulations with better safety profiles.
Enhanced antivenom quality is essential to reduce adverse events in snakebite management.