title: Antivenom therapy for crotaline snakebites: has the poison control center provided effective guidelines?
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yen-Chia
authors.initials: YC
authors.lastname: Chen
authors.forename: Min-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Lee-Min
authors.initials: LM
authors.lastname: Wang
authors.forename: Jackson Jer-Kan
authors.initials: JJ
authors.lastname: Wu
authors.forename: Chun-I
authors.initials: CI
authors.lastname: Huang
authors.forename: Chen-Hsen
authors.initials: CH
authors.lastname: Lee
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Yang
mesh_terms: 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
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms