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High-dose versus low-dose antivenom in the treatment of poisonous snake bites: A systematic review.

Das RR, Sankar J, Dev N - Indian J Crit Care Med (2015)

Bottom Line: We searched all the published literature through the major electronic databases till August 2014.There was no significant difference between the two groups for any of the outcomes except duration of hospital stay, which was lower in the low dose group.Low dose is also highly cost-effective as compared to the high dose.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

ABSTRACT
Though snake antivenom (SAV) is the mainstay of therapy for poisonous snake bites, there is no universally accepted standard regimen regarding the optimum dose (low vs. high). We therefore, undertook this systematic review to address this important research question. We searched all the published literature through the major electronic databases till August 2014. Randomized clinical trials (RCTs) were included. Eligible trials compared low versus high dose SAV in poisonous snake bite. The review has been registered at PROSPERO (Registration number: CRD42014009700). Of 36 citations retrieved, a total of 5 RCTs (n = 473) were included in the final analyses. Three trials were open-label, 4 conducted in Indian sub-continent and 1 in Brazil. The doses of SAV varied in the high dose group from 40 ml to 550 ml, and in the low dose group from 20 ml to 220 ml. There was no significant difference between the two groups for any of the outcomes except duration of hospital stay, which was lower in the low dose group. The GRADE evidence generated was of "very low quality." Low-dose SAV is equivalent or may be superior to high-dose SAV in management of poisonous snake bite. Low dose is also highly cost-effective as compared to the high dose. But the GRADE evidence generated was of "very low quality" as most were open label trials. Further trials are needed to make definitive recommendations regarding the dose and these should also include children <9 years of age.

No MeSH data available.


Related in: MedlinePlus

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Figure 1: Study flow (PRISMA Flow-chart)

Mentions: Of 36 citations retrieved, full text of 9 articles was assessed for eligibility [Figure 1]. Of these, a total of 5 RCTs were included [Table 1].[613141516] Five studies were excluded because of the following reasons: Compared two different antivenom preparations (n = 2), not RCTs (n = 2), and compared two different infusion rates (n = 1) [Table 2].[578171819] Three of the included studies were open label trials,[131415] four studies were conducted in India,[6131415] and one in Brazil.[16] Two were double-blinded studies.[616] A total of 473 participants including both children and adults were included in the analysis. The age of included children was ≥ 9 years. The doses of SAV varied in the high dose group from 40 ml to 550 ml, and in the low dose group from 20 ml to 220 ml. Only one trial tested the use of both dose schedules in all severity of snake envenomation (mild, moderate, and severe).[13]


High-dose versus low-dose antivenom in the treatment of poisonous snake bites: A systematic review.

Das RR, Sankar J, Dev N - Indian J Crit Care Med (2015)

Study flow (PRISMA Flow-chart)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4478675&req=5

Figure 1: Study flow (PRISMA Flow-chart)
Mentions: Of 36 citations retrieved, full text of 9 articles was assessed for eligibility [Figure 1]. Of these, a total of 5 RCTs were included [Table 1].[613141516] Five studies were excluded because of the following reasons: Compared two different antivenom preparations (n = 2), not RCTs (n = 2), and compared two different infusion rates (n = 1) [Table 2].[578171819] Three of the included studies were open label trials,[131415] four studies were conducted in India,[6131415] and one in Brazil.[16] Two were double-blinded studies.[616] A total of 473 participants including both children and adults were included in the analysis. The age of included children was ≥ 9 years. The doses of SAV varied in the high dose group from 40 ml to 550 ml, and in the low dose group from 20 ml to 220 ml. Only one trial tested the use of both dose schedules in all severity of snake envenomation (mild, moderate, and severe).[13]

Bottom Line: We searched all the published literature through the major electronic databases till August 2014.There was no significant difference between the two groups for any of the outcomes except duration of hospital stay, which was lower in the low dose group.Low dose is also highly cost-effective as compared to the high dose.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

ABSTRACT
Though snake antivenom (SAV) is the mainstay of therapy for poisonous snake bites, there is no universally accepted standard regimen regarding the optimum dose (low vs. high). We therefore, undertook this systematic review to address this important research question. We searched all the published literature through the major electronic databases till August 2014. Randomized clinical trials (RCTs) were included. Eligible trials compared low versus high dose SAV in poisonous snake bite. The review has been registered at PROSPERO (Registration number: CRD42014009700). Of 36 citations retrieved, a total of 5 RCTs (n = 473) were included in the final analyses. Three trials were open-label, 4 conducted in Indian sub-continent and 1 in Brazil. The doses of SAV varied in the high dose group from 40 ml to 550 ml, and in the low dose group from 20 ml to 220 ml. There was no significant difference between the two groups for any of the outcomes except duration of hospital stay, which was lower in the low dose group. The GRADE evidence generated was of "very low quality." Low-dose SAV is equivalent or may be superior to high-dose SAV in management of poisonous snake bite. Low dose is also highly cost-effective as compared to the high dose. But the GRADE evidence generated was of "very low quality" as most were open label trials. Further trials are needed to make definitive recommendations regarding the dose and these should also include children <9 years of age.

No MeSH data available.


Related in: MedlinePlus