Antivenom therapy for crotaline snakebites: has the poison control center provided effective guidelines?
Crotaline snakebites (Protobothrops mucrosquamatus and Trimeresurus stejnegeri) are a common medical emergency in Taiwan that can be effectively treated by a bivalent F(ab)2 antivenom. We investigated the differences in the clinical outcomes of patients who received different therapeutic regimens of antivenom in a medical center where clinical toxicologists followed the poison control center (PCC) guidelines (medical group) and surgeons did not (surgical group). The medical records of inpatients with crotaline snakebites between 1991 and 2005 were reviewed and information on demographics, treatments, adverse effects of antivenom, and complications was abstracted and analyzed. A total of 179 patients (90 medical, 89 surgical) were eligible for study. There was no significant intergroup difference in baseline characteristics except that the dose of antivenom and the probability of antibiotic use were both higher in the surgical group (5.9 +/- 4.2 vials vs. 2.7 +/- 1.6 vials; 93% vs. 60%). Multiple logistic regression adjusting for age, gender, calendar year of envenomation, severity of envenomation, and antibiotic use did not disclose evidence of any difference in various clinical outcomes between medical and surgical patients. The lower dose of antivenom recommended by the PCC may be as effective and safe as the higher dose used in the surgical group for the treatment of crotaline snakebites.
Chen
Yen-Chia
YC
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Chen
Min-Hui
MH
Wang
Lee-Min
LM
Wu
Jackson Jer-Kan
JJ
Huang
Chun-I
CI
Lee
Chen-Hsen
CH
Yen
David Hung-Tsang
DH
Yang
Chen-Chang
CC
D000818:Animals; D000997:Antivenins / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011039:Poison Control Centers; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012909:Snake Bites / Q000628:therapy*; D013624:Taiwan; D017841:Trimeresurus; D017819:Viperidae
D000997:Antivenins; D003435:Crotalid Venoms