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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

Secondary outcome: Bleeding or disseminated intravascular coagulation rate
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Figure 5: Secondary outcome: Bleeding or disseminated intravascular coagulation rate

Mentions: Bleeding or DIC: This was reported in 4 trials.[6131416] But the result could be pooled from 2 trials that showed no significant difference in the bleeding or DIC rate,[613] with the point estimate favoring the low dose group (RR, 0.77; 95% CI, 0.46–1.29) [Figure 5]. Of the other 2 trials, one did not find any bleeding or DIC in the low dose group,[14] where as in the other largest trial (n = 170), majority showed rapid clinical improvement after treatment with either dose regimen (rapid restoration of blood coagulability and cessation of bleeding)[16]


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)

Secondary outcome: Bleeding or disseminated intravascular coagulation rate
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Secondary outcome: Bleeding or disseminated intravascular coagulation rate
Mentions: Bleeding or DIC: This was reported in 4 trials.[6131416] But the result could be pooled from 2 trials that showed no significant difference in the bleeding or DIC rate,[613] with the point estimate favoring the low dose group (RR, 0.77; 95% CI, 0.46–1.29) [Figure 5]. Of the other 2 trials, one did not find any bleeding or DIC in the low dose group,[14] where as in the other largest trial (n = 170), majority showed rapid clinical improvement after treatment with either dose regimen (rapid restoration of blood coagulability and cessation of bleeding)[16]

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