Crotaline Fab antivenom for the treatment of children with rattlesnake envenomation.
OBJECTIVE
There is little data regarding safety or efficacy of Crotalinae polyvalent immune Fab (ovine) antivenom (crotaline Fab) in pediatric patients. Our objective was to provide the first information regarding safety and effectiveness of this new drug in children.


METHODS
Data were collected prospectively and retrospectively for all consecutive pediatric patients bitten by rattlesnakes and treated at 2 urban hospitals during 2001. Cases were included if there were signs of envenomation at presentation, patient age was 13 years or less, and there was administration of crotaline Fab. Cases were excluded if antivenin (Crotalidae) polyvalent (equine origin, the conventional antivenom) was given. Primary outcome variables were snakebite severity scores throughout the course of therapy, number of vials of crotaline Fab administered, occurrence of allergic reactions, adjunct surgical therapy, and the presence of permanent sequelae or serum sickness identified at follow-up.


RESULTS
In the 12 cases studied, ages ranged from 14 months to 13 years (mean: 6.9; standard deviation: 4.2). Presentation snakebite severity scores ranged from 2 to 9 (mean: 5.3; standard deviation: 2.3). Total crotaline Fab doses ranged from 4 to 22 vials (mean: 12.7; standard deviation: 5.4). Initial control of symptoms was achieved with 4 to 16 vials (mean: 7.7; standard deviation: 3.7), and severity scores stabilized or improved within 24 hours in all patients. Recurrence of local swelling occurred in 1 case despite scheduled repeat doses of antivenom. No cases required surgical intervention, and no permanent sequelae were identified. No immediate or delayed hypersensitivity reactions occurred.


CONCLUSIONS
In this group of pediatric patients treated for rattlesnake envenomation, crotaline Fab antivenom was safe and seemed to be effective.
Offerman
Steven R
SR
Division of Medical Toxicology, Department of Emergency Medicine UCSD Medical Center, San Diego, California, USA.
Bush
Sean P
SP
Moynihan
James A
JA
Clark
Richard F
RF
D000293:Adolescent; D000997:Antivenins; D002648:Child; D002675:Child, Preschool; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D011039:Poison Control Centers / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012909:Snake Bites / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments