title: Efficacy of scorpion antivenom plus prazosin versus prazosin alone for Mesobuthus tamulus scorpion sting envenomation in children: a randomised controlled trial.
abstract: OBJECTIVE
  To assess the efficacy of combined use of scorpion antivenom (SAV) with prazosin, compared with prazosin alone in children with Mesobuthus tamulus scorpion envenomation.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  A tertiary care hospital in south India.
  
  
  METHODS
  50 children with definite history and/or systemic manifestations of scorpion envenomation were recruited from the paediatric emergency or outpatient department from February 2012 to July 2013.
  
  
  METHODS
  The children were randomised into two groups. In 25 children, SAV was administrated as a slow intravenous bolus combined with prazosin (group A). Others received prazosin alone (group B). Results were analysed by Student t test and χ(2) test.
  
  
  METHODS
  Time required for resolution of autonomic symptoms, total dose of prazosin, adverse events.
  
  
  RESULTS
  Children in group A recovered earlier than those in group B (mean difference 9.1 h, 95% CI 6.0 to 12.2). 23 children (92%) in group A were clear of autonomic symptoms within 10 h, compared with 10 children (40%) in group B (mean difference 52%, 95% CI 29% to 75%). The proportion of children deteriorating to clinical grade 3 or 4 was 8% in group A as against 44% in group B (p<0.01). The mean dose of prazosin required was 54 µg/kg versus 130.8 µg/kg in group A and B, respectively (p<0.01). SAV was not associated with severe adverse reactions.
  
  
  CONCLUSIONS
  Usage of SAV led to faster recovery and reduced the incidence of myocardial dysfunction. Combined therapy with SAV and prazosin is beneficial for children with M tamulus scorpion envenomation.
  
  
  BACKGROUND
  CTRI/2013/09/004002 (Clinical Trials Registry of India).
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Karuppiah
authors.initials: K
authors.lastname: Pandi
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Sriram
authors.initials: S
authors.lastname: Krishnamurthy
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Rangan
authors.initials: R
authors.lastname: Srinivasaraghavan
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Mahadevan
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000008:administration & dosage*; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007194:India; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D011224:Prazosin / Q000008:administration & dosage* / Q000627:therapeutic use; D065008:Scorpion Stings / Q000188:drug therapy*; D012604:Scorpion Venoms; D012605:Scorpions; D016896:Treatment Outcome
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000997:Antivenins; D007155:Immunologic Factors; D012604:Scorpion Venoms; D011224:Prazosin
keywords: General Paediatrics; Paediatric Practice; Tropical Paediatrics