title: Antivenin remains effective against African Viperidae bites despite a delayed treatment.
abstract: BACKGROUND
  Viperidae bites represent a public health issue in Africa and are responsible for a hemorrhagic syndrome with fatal outcome in the short term. A research on Medline database does not reveal any data definitively demonstrating the efficiency of antivenom in case of delayed administration. The aim of this study, based on a 12-year survey of viperine syndromes in Republic of Djibouti, was to compare the normalization of the hemostasis disorders with an early administration of antivenin versus a delayed administration.
  
  
  METHODS
  A retrospective study was conducted from October 1994 to May 2006 in the intensive care unit of the French military Hospital, in Djibouti. Seventy-three Viperidae-envenomed patients were included. Antivenin efficiency in correcting hemostatic disorders was analyzed in relation to time to treatment (before or after the 24th hour after the bite).
  
  
  RESULTS
  Forty-two patients (58%) presented with bleeding. A consumptive coagulopathy was found in 68 patients (93%). Antivenin was observed to be effective in improving hemostasis, and the time to normalization of biologic parameters was similar, whether the treatment was started before or after the 24th hour after the bite.
  
  
  CONCLUSIONS
  Antivenin should ideally be administered as early as possible. However, in Africa, time to treatment generally exceeds 24 hours. The results of the present evidence-based study confirm an empirical concept: a delayed time to treatment should in no way counterindicate the use of antivenin immunotherapy, in the case of African Viperidae bites.
authors.affiliation: Service médical, 11(ème)RAMa, Saint Aubin du Cormier, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Larréché
authors.forename: Georges
authors.initials: G
authors.lastname: Mion
authors.forename: Aurélie
authors.initials: A
authors.lastname: Mayet
authors.forename: Catherine
authors.initials: C
authors.lastname: Verret
authors.forename: Marc
authors.initials: M
authors.lastname: Puidupin
authors.forename: Alain
authors.initials: A
authors.lastname: Benois
authors.forename: Fabrice
authors.initials: F
authors.lastname: Petitjeans
authors.forename: Nicolas
authors.initials: N
authors.lastname: Libert
authors.forename: Max
authors.initials: M
authors.lastname: Goyffon
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015730:Djibouti; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012909:Snake Bites / Q000628:therapy*; D016896:Treatment Outcome; D017819:Viperidae; D055815:Young Adult
chemical_list: D000997:Antivenins