Intervention Review

Interventions for preventing reactions to snake antivenom

  1. Issarang Nuchprayoon1,*,
  2. Paul Garner2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 25 OCT 1999

Assessed as up-to-date: 6 JUL 1999

DOI: 10.1002/14651858.CD002153


How to Cite

Nuchprayoon I, Garner P. Interventions for preventing reactions to snake antivenom. Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD002153. DOI: 10.1002/14651858.CD002153.

Author Information

  1. 1

    Faculty of Medicine, Chulalongkorn University, Pediatrics, Bangkok, Thailand

  2. 2

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK

*Issarang Nuchprayoon, Pediatrics, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand. fmedinp@md2.md.chula.ac.th.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 25 OCT 1999

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Antivenom is used to neutralise snake bite toxins in people showing evidence of envenomation. It is made from animal sera, and adverse effects, including life threatening anaphylaxis, are common.

Objectives

To assess the effects of drugs given routinely with snake antivenom to prevent adverse effects.

Search methods

Cochrane controlled trials register; contact with researchers in the field.

Selection criteria

Randomized and quasi-randomized trials testing routine adrenaline (epinephrine), antihistamines, or corticosteroids.

Data collection and analysis

The two authors applied the inclusion criteria, assessed trial quality, and extracted the data. We sought additional data from trialists where required.

Main results

One trial in Sri Lanka (n = 105) giving adrenaline with polyspecific antivenom showed fewer adverse reactions in the adrenaline group, and this effect was preserved when stratified for severity. One trial in Brazil (n = 101) using three types of Bothrops antivenom showed no benefit of antihistamine drugs.

Authors' conclusions

Routine prophylactic adrenaline for polyvalent antivenom known to have high adverse event rates seems sensible, based on this one trial. If clinicians believe local factors do not justify routine adrenaline, then they should test their belief in a randomized trial. Antihistamine appears to be of no obvious benefit in preventing acute reactions from antivenoms.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for preventing reactions to snake antivenom

People die or can be seriously disabled after being bitten by a venomous snake. Different venomous snake species have different effects on the body, but initial treatment is similar - to try and prevent venom entering the general circulation. If it becomes apparent that the venom has reached the bloodstream, the patients start becoming extremely unwell and in these circumstances health staff may give a specific antivenom (made from horse serum). However, antivenom frequently causes adverse effects which can, in themselves, be severe and result in death.

There are drugs that can be given with the antivenom to try to reduce these adverse effects, and these include adrenaline, antihistamines, and steroids. The review looked to assess the benefit of giving these drugs along with the antivenom. The review of trials found one trial of 105 people in Sri Lanka looking at adrenaline; and a second trial of 101 people in Brazil looking at an antihistamine (promethazine). Both trials were well designed. Adrenaline showed fewer allergic reactions. There was no benefit seen from giving promethazine, and no trials were found on late allergic responses, nor on corticosteroids.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防抗蛇毒血清不良反應之措施

當有證據顯示蛇毒液螫入體內時抗蛇毒血清被用來中和蛇咬毒素。抗蛇毒血清由動物血清所做成,其副作用,包括威脅生命的過敏症,是常見的。

目標

評估日常例行使用來預防抗蛇毒血清副作用藥物的效果。

搜尋策略

Cochrane控制試驗登錄庫; 與本領域內之研究者聯絡。

選擇標準

測試例行使用腎上腺素(腎上腺素),抗組織胺或者類皮質激素的隨機和類隨機式試驗.

資料收集與分析

二位作者應用納入標準,估計試驗品質,並且提取數據。如果有需要時我們也從試驗者尋找額外的數據。

主要結論

一個在斯里蘭卡完成的試驗(n = 105)同時給予腎上腺素與多特異性抗蛇毒血清的結果顯示在腎上腺素組較少發生副作用,並且當以嚴重度分類時這個效果依然存在。一個在巴西完成的試驗(n = 101)使用具竅蝮蛇屬的抗蛇毒血清的三種類型顯示給予抗組胺藥物沒有好處。

作者結論

根據這個試驗,例行使用腎上腺素來防範已知的多價抗蛇毒血清的副作用似乎是合理的。如果臨床醫師認為該地區不能認同腎上腺素之例行使用,他們應該進行一隨機式的試驗去檢討該信念。抗組織胺看來在防止抗蛇毒血清的急性反應沒有明顯的好處。

翻譯人

本摘要由三軍總醫院陳佳宏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

預防抗蛇毒血清不良反應之措施蛇咬之後毒蛇毒液螫入可以造成人類死亡或嚴重殘疾。不同毒蛇種類對身體有不同的作用,但是最初治療是相似的嘗試和防止毒液進入全身循環。如果得明顯地毒液已進入了血液,患者開始變得極端不適,醫療人員在這種情形下便會給與特定抗蛇毒血清(由馬血清做成)。 然而,抗蛇毒血清常常導致很嚴重和造成死亡的副作用。有可以給予抗蛇毒血清來減少這些副作用的藥物,這些包括腎上腺素、抗組胺和類固醇。本回顧評估了與抗蛇毒血清一起給予的這些藥物的好處。本回顧發現在斯里蘭卡執行的一個105個人使用腎上腺素的試驗; 並且發現另一個在巴西執行的101個人使用抗組織胺(promethazine)的試驗。兩個試驗均設計良好。 使用腎上腺素可降低過敏反應。Promethazine沒有好處。沒有發現治療晚期過敏反應與使用類皮質激素的試驗。