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

<h4>Background</h4>Snake envenoming is a major clinical problem in Sri Lanka, with an estimated 40,000 bites annually. Antivenom is only available from India and there is a high rate of systemic hypersensitivity reactions. This study aimed to investigate whether the rate of infusion of a...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Geoffrey K Isbister, Seyed Shahmy, Fahim Mohamed, Chandana Abeysinghe, Harendra Karunathilake, Ariaranee Ariaratnam
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0ae4a238dcd4480bb7f409bb76dc0c64
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:0ae4a238dcd4480bb7f409bb76dc0c64
record_format	dspace
spelling	oai:doaj.org-article:0ae4a238dcd4480bb7f409bb76dc0c642021-11-18T07:15:17ZA randomised controlled trial of two infusion rates to decrease reactions to antivenom.1932-620310.1371/journal.pone.0038739https://doaj.org/article/0ae4a238dcd4480bb7f409bb76dc0c642012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22719932/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Snake envenoming is a major clinical problem in Sri Lanka, with an estimated 40,000 bites annually. Antivenom is only available from India and there is a high rate of systemic hypersensitivity reactions. This study aimed to investigate whether the rate of infusion of antivenom reduced the frequency of severe systemic hypersensitivity reactions.<h4>Methods and findings</h4>This was a randomized comparison trial of two infusion rates of antivenom for treatment of non-pregnant adult patients (>14 y) with snake envenoming in Sri Lanka. Snake identification was by patient or hospital examination of dead snakes when available and confirmed by enzyme-immunoassay for Russell's viper envenoming. Patients were blindly allocated in a 11 randomisation schedule to receive antivenom either as a 20 minute infusion (rapid) or a two hour infusion (slow). The primary outcome was the proportion with severe systemic hypersensitivity reactions (grade 3 by Brown grading system) within 4 hours of commencement of antivenom. Secondary outcomes included the proportion with mild/moderate hypersensitivity reactions and repeat antivenom doses. Of 1004 patients with suspected snakebites, 247 patients received antivenom. 49 patients were excluded or not recruited leaving 104 patients allocated to the rapid antivenom infusion and 94 to the slow antivenom infusion. The median actual duration of antivenom infusion in the rapid group was 20 min (Interquartile range[IQR]:20-25 min) versus 120 min (IQR:75-120 min) in the slow group. There was no difference in severe systemic hypersensitivity reactions between those given rapid and slow infusions (32% vs. 35%; difference 3%; 95%CI:-10% to +17%;p = 0.65). The frequency of mild/moderate reactions was also similar. Similar numbers of patients in each arm received further doses of antivenom (30/104 vs. 23/94).<h4>Conclusions</h4>A slower infusion rate would not reduce the rate of severe systemic hypersensitivity reactions from current high rates. More effort should be put into developing better quality antivenoms.<h4>Trial registration</h4>www.slctr.lk SLCTR/2007/005.Geoffrey K IsbisterSeyed ShahmyFahim MohamedChandana AbeysingheHarendra KarunathilakeAriaranee AriaratnamPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 6, p e38739 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Geoffrey K Isbister Seyed Shahmy Fahim Mohamed Chandana Abeysinghe Harendra Karunathilake Ariaranee Ariaratnam A randomised controlled trial of two infusion rates to decrease reactions to antivenom.
description	<h4>Background</h4>Snake envenoming is a major clinical problem in Sri Lanka, with an estimated 40,000 bites annually. Antivenom is only available from India and there is a high rate of systemic hypersensitivity reactions. This study aimed to investigate whether the rate of infusion of antivenom reduced the frequency of severe systemic hypersensitivity reactions.<h4>Methods and findings</h4>This was a randomized comparison trial of two infusion rates of antivenom for treatment of non-pregnant adult patients (>14 y) with snake envenoming in Sri Lanka. Snake identification was by patient or hospital examination of dead snakes when available and confirmed by enzyme-immunoassay for Russell's viper envenoming. Patients were blindly allocated in a 11 randomisation schedule to receive antivenom either as a 20 minute infusion (rapid) or a two hour infusion (slow). The primary outcome was the proportion with severe systemic hypersensitivity reactions (grade 3 by Brown grading system) within 4 hours of commencement of antivenom. Secondary outcomes included the proportion with mild/moderate hypersensitivity reactions and repeat antivenom doses. Of 1004 patients with suspected snakebites, 247 patients received antivenom. 49 patients were excluded or not recruited leaving 104 patients allocated to the rapid antivenom infusion and 94 to the slow antivenom infusion. The median actual duration of antivenom infusion in the rapid group was 20 min (Interquartile range[IQR]:20-25 min) versus 120 min (IQR:75-120 min) in the slow group. There was no difference in severe systemic hypersensitivity reactions between those given rapid and slow infusions (32% vs. 35%; difference 3%; 95%CI:-10% to +17%;p = 0.65). The frequency of mild/moderate reactions was also similar. Similar numbers of patients in each arm received further doses of antivenom (30/104 vs. 23/94).<h4>Conclusions</h4>A slower infusion rate would not reduce the rate of severe systemic hypersensitivity reactions from current high rates. More effort should be put into developing better quality antivenoms.<h4>Trial registration</h4>www.slctr.lk SLCTR/2007/005.
format	article
author	Geoffrey K Isbister Seyed Shahmy Fahim Mohamed Chandana Abeysinghe Harendra Karunathilake Ariaranee Ariaratnam
author_facet	Geoffrey K Isbister Seyed Shahmy Fahim Mohamed Chandana Abeysinghe Harendra Karunathilake Ariaranee Ariaratnam
author_sort	Geoffrey K Isbister
title	A randomised controlled trial of two infusion rates to decrease reactions to antivenom.
title_short	A randomised controlled trial of two infusion rates to decrease reactions to antivenom.
title_full	A randomised controlled trial of two infusion rates to decrease reactions to antivenom.
title_fullStr	A randomised controlled trial of two infusion rates to decrease reactions to antivenom.
title_full_unstemmed	A randomised controlled trial of two infusion rates to decrease reactions to antivenom.
title_sort	randomised controlled trial of two infusion rates to decrease reactions to antivenom.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/0ae4a238dcd4480bb7f409bb76dc0c64
work_keys_str_mv	AT geoffreykisbister arandomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT seyedshahmy arandomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT fahimmohamed arandomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT chandanaabeysinghe arandomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT harendrakarunathilake arandomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT ariaraneeariaratnam arandomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT geoffreykisbister randomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT seyedshahmy randomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT fahimmohamed randomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT chandanaabeysinghe randomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT harendrakarunathilake randomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom AT ariaraneeariaratnam randomisedcontrolledtrialoftwoinfusionratestodecreasereactionstoantivenom
_version_	1718423707967291392

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

Ejemplares similares