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Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil

Pardal, P. P. D., Souza, S. M., Monteiro, M. R. D. D., Fan, H. W., Cardoso, J. L. C., Franca, F. O. S., Tomy, S. C., Sano-Martins, I. S., de Sousa-E-Silva, M. C. C., Colombini, M., Kodera, N. F., Moura-Da-Silva, A. M., Cardoso, D. F., Velarde, D. T., Kamiguti, A. S., Theakston, R.David G. and Warrell, David A. (2004) 'Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil'. Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol 98, Issue 1, pp. 28-42.

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Abstract

The efficacies of specific Bothrops atrox-Lachesis and standard Bothrops-Lachesis antivenoms were compared in the north eastern Amazon region of Brazil. The main aim was to investigate whether a specific antivenom raised against the venom of B. atrox, the most important Amazon snake species from a medical point of view, was necessary for the treatment of patients in this region. Seventy-four patients with local and systemic effects of envenoming by Bothrops or Lachesis snakes were randomly allocated to receive either specific (n = 38) or standard (n = 36) antivenoms. In 46 cases (24 in the standard antivenom group, 22 in the other) the snake was identified either by enzyme immunoassay or by examination of the dead snake, as B. atrox in 45, L. muta in one. Patients were similar in all clinical and epidemiological respects before treatment. Results indicated that both antivenoms were equally effective in reversing all signs of envenoming detected both clinically and in the laboratory. Venom-induced haemostatic abnormalities were resolved within 24 In after the start of antivenom therapy in most patients. The extent of local complications, such as local skin necrosis and secondary infection, was similar in both groups. There were no deaths. The incidence of early anaphylactic reactions was 18% and 19%, respectively for specific and standard antivenoms; none was life-threatening. Measurement of serum venom concentrations by enzyme immunoassay (EIA) confirmed that both antivenoms cleared venom antigenaemia effectively. EIA also revealed that one patient had been bitten by Lachesis muta, although the clinical features in this case were not distinctive. (C) 2003 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Item Type: Article
Uncontrolled Keywords: snakebite antivenom clinical trial bothrops atrox lachesis muta amazonia brazil randomized comparative trial snake bites blood-coagulation patients bitten jararaca venom sao-paulo atrox colombia muta moojeni
Subjects: QV Pharmacology > Toxicology > General Toxicology > QV 601 Antidotes and other therapeutic measures
QV Pharmacology > Drug Standardization. Pharmacognosy. Medicinal Plants > QV 771 Standardization and evaluation of drugs
QW Microbiology and Immunology > Antigens and Antibodies. Toxins and Antitoxins > QW 630 Toxins. Antitoxins
WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Animal Poisons > WD 410 Reptiles
Faculty: Department: Groups (2002 - 2012) > Molecular & Biochemical Parasitology Group
Digital Object Identifer (DOI): https://doi.org/10.1016/S0035-9203(03)00005-1
Depositing User: Martin Chapman
Date Deposited: 01 Mar 2012 12:09
Last Modified: 06 Feb 2018 13:03
URI: http://archive.lstmed.ac.uk/id/eprint/2234

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