Antivenom therapy for snakebites in children: is there evidence?
OBJECTIVE
A new Fab fragment antivenom (CroFab) for the treatment of crotaline envenomation, the predominant venomous snakebite in the United States, has drastically changed snakebite management since its release in December 2000. This review examines the evidence supporting the use of CroFab, with particular attention on the pediatric population.


RESULTS
The published experience with CroFab in humans consists of six studies and some case reports. These publications demonstrate that CroFab is highly efficacious in treating both the local and systemic toxic effects of crotaline envenomation. They identify an important phenomenon of recurrent or delayed toxicity in some patients. The studies report a very low incidence of acute or delayed hypersensitivity reactions to the antivenom. They suggest comparable efficacy and safety of CroFab in the pediatric population as in adults.


CONCLUSIONS
Based on limited data, CroFab has been shown to be a safe and efficacious antivenom for use in children as well as adults. Further studies are needed to refine our understanding of its efficacy, safety, indications, and dosing.
Schmidt
James M
JM
Division of Emergency Medicine, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA. schmidjm@chkd.org
D000997:Antivenins / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors / Q000506:poisoning; D005076:Exanthema / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000009:adverse effects / Q000627:therapeutic use*; D011537:Pruritus / Q000139:chemically induced; D012909:Snake Bites / Q000188:drug therapy*; D012910:Snake Venoms / Q000037:antagonists & inhibitors* / Q000506:poisoning; D016896:Treatment Outcome
D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments; D012910:Snake Venoms