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Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite.
Ann Emerg Med. 2004 Feb; 43(2):200-6.AE

Abstract

STUDY OBJECTIVE

Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) effectively treats patients bitten by rattlesnakes. The copperhead snake (Agkistrodon contortrix) caused 37% of venomous snakebites reported to US poison centers in 2001 and is the major envenomating reptile in the southeastern United States. FabAV has not been tested in human beings envenomated by copperhead snakes.

METHODS

In this preliminary study, we performed a retrospective chart review of all copperhead snake envenomations reported to the Carolinas Poison Center that were treated with FabAV. Progression of limb swelling, coagulopathy, and hemodynamic status before and after FabAV administration, adverse effects of FabAV therapy, and recurrence phenomena were recorded.

RESULTS

Of approximately 400 copperhead envenomation cases reported to the poison center during the study period, 32 received FabAV and were included. Most patients had moderate envenomation. The median time to FabAV administration was 4.0 hours. The median time to achieve initial control was 1.0 hour, with a median dose of 4 vials of FabAV. A rapid initial response, defined as cessation of the progression of local tissue injury within 4 hours of FabAV administration, occurred in 28 cases (88%; 95% confidence interval [CI] 76% to 99%). Four cases (13%; 95% CI 1% to 24%) were considered treatment failures. Recurrent swelling occurred in 6 cases (19%; 95% CI 5% to 32%). The incidence of recurrent swelling was not reduced by administration of repeated doses of antivenom on a planned schedule. One patient developed late-onset coagulopathy. One minor allergic reaction was observed.

CONCLUSION

In this select group of patients bitten by copperhead snakes, local tissue effects of envenomation halted promptly after FabAV treatment in most cases. Treatment failures occurred, and recurrence of swelling and defibrination syndrome was sometimes problematic. Time to return to work and long-term limb function were not assessed. A controlled trial with long-term follow-up is needed to define the role of FabAV treatment for copperhead envenomation.

Authors+Show Affiliations

Division of Medical Toxicology, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861, USA. eric.lavonas@carolinashealthcare.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14747809

Citation

Lavonas, Eric J., et al. "Initial Experience With Crotalidae Polyvalent Immune Fab (ovine) Antivenom in the Treatment of Copperhead Snakebite." Annals of Emergency Medicine, vol. 43, no. 2, 2004, pp. 200-6.
Lavonas EJ, Gerardo CJ, O'Malley G, et al. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med. 2004;43(2):200-6.
Lavonas, E. J., Gerardo, C. J., O'Malley, G., Arnold, T. C., Bush, S. P., Banner, W., Steffens, M., & Kerns, W. P. (2004). Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Annals of Emergency Medicine, 43(2), 200-6.
Lavonas EJ, et al. Initial Experience With Crotalidae Polyvalent Immune Fab (ovine) Antivenom in the Treatment of Copperhead Snakebite. Ann Emerg Med. 2004;43(2):200-6. PubMed PMID: 14747809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. AU - Lavonas,Eric J, AU - Gerardo,Charles J, AU - O'Malley,Gerald, AU - Arnold,Thomas C, AU - Bush,Sean P, AU - Banner,William,Jr AU - Steffens,Mark, AU - Kerns,William P,2nd PY - 2004/1/30/pubmed PY - 2004/9/4/medline PY - 2004/1/30/entrez SP - 200 EP - 6 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 43 IS - 2 N2 - STUDY OBJECTIVE: Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) effectively treats patients bitten by rattlesnakes. The copperhead snake (Agkistrodon contortrix) caused 37% of venomous snakebites reported to US poison centers in 2001 and is the major envenomating reptile in the southeastern United States. FabAV has not been tested in human beings envenomated by copperhead snakes. METHODS: In this preliminary study, we performed a retrospective chart review of all copperhead snake envenomations reported to the Carolinas Poison Center that were treated with FabAV. Progression of limb swelling, coagulopathy, and hemodynamic status before and after FabAV administration, adverse effects of FabAV therapy, and recurrence phenomena were recorded. RESULTS: Of approximately 400 copperhead envenomation cases reported to the poison center during the study period, 32 received FabAV and were included. Most patients had moderate envenomation. The median time to FabAV administration was 4.0 hours. The median time to achieve initial control was 1.0 hour, with a median dose of 4 vials of FabAV. A rapid initial response, defined as cessation of the progression of local tissue injury within 4 hours of FabAV administration, occurred in 28 cases (88%; 95% confidence interval [CI] 76% to 99%). Four cases (13%; 95% CI 1% to 24%) were considered treatment failures. Recurrent swelling occurred in 6 cases (19%; 95% CI 5% to 32%). The incidence of recurrent swelling was not reduced by administration of repeated doses of antivenom on a planned schedule. One patient developed late-onset coagulopathy. One minor allergic reaction was observed. CONCLUSION: In this select group of patients bitten by copperhead snakes, local tissue effects of envenomation halted promptly after FabAV treatment in most cases. Treatment failures occurred, and recurrence of swelling and defibrination syndrome was sometimes problematic. Time to return to work and long-term limb function were not assessed. A controlled trial with long-term follow-up is needed to define the role of FabAV treatment for copperhead envenomation. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/14747809/Initial_experience_with_Crotalidae_polyvalent_immune_Fab__ovine__antivenom_in_the_treatment_of_copperhead_snakebite_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196064403009296 DB - PRIME DP - Unbound Medicine ER -