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Author Spotlight: Optimizing Scorpion Venom Extraction for Antivenom Production
Published on: October 6, 2023
A Randomized Controlled Trial to Optimize Antivenom Therapy for Carpet Viper (Echis romani)-Envenomed Children in
Nicholas A Hamman1, Agom D Ibrahim2, Muhammad Hamza3
1Kaltungo Snakebite Research Hospital, Gombe State, Nigeria.
Insights
A study found that a single vial of EchiTAb-plus-ICP (EPI) antivenom is as effective and safe as two vials for treating carpet viper envenoming in Nigerian children. This finding supports using the lower dose for carpet viper bites.
Area of Science:
- * Tropical Medicine
- * Clinical Toxicology
- * Pharmacology
Background:
- * Carpet viper (Echis romani) envenoming is a significant health concern in Nigeria, often leading to systemic envenoming characterized by incoagulable blood.
- * The standard treatment involves antivenom, but optimal dosing and administration for moderate envenoming in children require further investigation.
Purpose of the Study:
- * To compare the efficacy and safety of one vial (10 mL) versus two vials (20 mL) of EchiTAb-plus-ICP (EPI) antivenom in children with moderate carpet viper envenoming.
- * To evaluate the impact of administration method (bolus vs. slow infusion) on treatment outcomes.
Main Methods:
- * An open randomized controlled trial was conducted in northeastern Nigeria.
- * Children with moderate systemic envenoming, diagnosed by the 20-minute whole blood clotting test (20WBCT), were randomly assigned to receive either one or two vials of EPI antivenom.
- * Blood coagulability was assessed using 20WBCT at 6, 12, 24, and 48 hours post-treatment; early adverse reactions were also monitored.
Main Results:
- * Permanent restoration of blood coagulability at 6 hours was achieved in 87.2% of children receiving one vial and 95.1% receiving two vials (P = 0.258).
- * Bolus administration showed a trend towards faster clotting restoration compared to slow infusion (97.6% vs. 84.2%, P = 0.049), though this difference was not sustained.
- * No significant differences in early adverse reactions were observed between different doses or administration methods.
Conclusions:
- * A single vial of EchiTAb-plus-ICP (EPI) antivenom is effective and safe for treating moderate carpet viper envenoming in children in Nigeria.
- * The findings suggest that a lower dose of EPI antivenom can be considered for this patient population, potentially reducing treatment costs.
- * Further research may explore optimal administration routes for antivenom therapy in viper envenoming.
Abstract:
In an open randomized controlled trial, we compared one vial (10 mL) to two vials (20 mL) of EchiTAb-plus-ICP (EPI) antivenom among children with systemic carpet viper (Echis romani) envenoming of moderate severity in northeastern Nigeria. Systemic envenoming, presenting with incoagulable blood, was diagnosed using the 20-minute whole blood clotting test (20WBCT). Eligible patients with positive 20WBCT whose guardians assented were recruited and randomly allocated to receive either one vial or two vials of EPI administered either as a bolus or as a slow continuous infusion. The primary outcome was permanent restoration of blood coagulability 6 hours after the start of treatment, assessed by the 20WBCT and repeated at 6, 12, 24, and 48 hours after treatment. Secondary outcomes were the incidences of early adverse reactions to antivenom treatment. Initial doses permanently restored blood coagulability at 6 hours in 34/39 (87.2%) of those treated with one vial and 39/41 (95.1%) of those treated with two vials of EPI (P = 0.258). However, the proportion with permanent restoration of clotting at 6 hours among patients randomized to bolus administration was 41 of 42 (97.6%) patients compared with 32 of 38 (84.2%) patients randomized to slow infusion of EPI antivenom (P = 0.049); however, the difference was not sustained through the remaining time points. There was no difference in early adverse reactions between those treated with the two different doses or modes of delivery. We conclude that the one-vial dose compared favorably to two vials of EPI antivenom with regards to effectiveness and safety among children with carpet viper envenoming of moderate severity in Nigeria.
