a randomised controlled trial of two infusion rates to decrease reactions to antivenom两个注入率的随机对照试验来减少反应抗蛇毒素.pdfVIP

A Randomised Controlled Trial of Two Infusion Rates to Decrease Reactions to Antivenom 1,2 2 2 3 Geoffrey K. Isbister *, Seyed Shahmy , Fahim Mohamed , Chandana Abeysinghe , Harendra Karunathilake3, Ariaranee Ariaratnam4 1 Discipline of Clinical Pharmacology, University of Newcastle, Newcastle, New South Wales, Australia, 2 South Asian Clinical Toxicology Research Collaboration, Peradeniya, Central Province, Sri Lanka, 3 Department of Medicine, Polonnaruwa General Hospital, North Central Province, Polonnaruwa, Sri Lanka, 4 Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Abstract Background: Snake envenoming is a major clinical problem in Sri Lanka, with an estimated 40,000 bites annually. Antivenom is only available from India and there is a high rate of systemic hypersensitivity reactions. This study aimed to investigate whether the rate of infusion of antivenom reduced the frequency of severe systemic hypersensitivity reactions. Methods and Findings: This was a randomized comparison trial of two infusion rates of antivenom for treatment of non- pregnant adult patients (.14 y) with snake envenoming in Sri Lanka. Snake identification was by patient or hospital examination of dead snakes when available and confirmed by enzyme-immunoassay for Russell’s viper envenoming. Patients were blindly allocated in a 11 randomisation schedule to receive antivenom either as a 20 minute infusion (rapid) or a two hour infusion (slow). The primary outcome was the proportion with severe systemic hypersensitivity reactions (grade 3 by Brown grading system) within 4 hours of commencement of antivenom. Secondary outcomes included the proportion