Tags

Type your tag names separated by a space and hit enter

Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: an integrative review.
BMC Emerg Med. 2009 Jun 22; 9:13.BE

Abstract

BACKGROUND

In 2000, the United States Food and Drug Administration approved Crotalidae Polyvalent Immune Fab (Ovine) (hereafter, FabAV), "for the management of patients with minimal to moderate North American Crotalid envenomation." Because whole-IgG pit viper antivenom is no longer available in the United States, FabAV is currently the only specific treatment option available to United States clinicians treating snakebite victims of any severity. No clinical trial data are available concerning the effectiveness of FabAV for treatment of severe snakebite, but several published articles describe its use in this setting.

METHODS

We performed a comprehensive review of the English-language medical literature to identify all publications (1996 to July, 2008) containing data about the administration of FabAV. Two trained reviewers separately extracted case-level data concerning the administration of FabAV to patients with severe envenomation by North American crotaline snakes to a standardized form. Descriptive statistics were used. In addition, we hand-searched the US National Poison Data System reports for the years 2000-2006 to identify and describe any reports of death that occurred after FabAV administration.

RESULTS

The literature review found 147 unique publications regarding FabAV. Twenty-four evaluable cases of severe human envenomation treated with FabAV were identified in 19 publications. Seven cases were described in five cohort studies, and 17 cases were described in 14 single patient case reports or non-cohort case series. Sixty-five specific severe venom effects were reported in these 24 patients, of which 50 effects (77%) improved or resolved after FabAV therapy. Initial control of all severe venom effects was achieved in 12 patients (50%). The rate at which initial control was achieved was significantly higher among patients reported in the cohort series than in the case series and non-cohort reports (100% vs. 29%, P = 0.005). The median dose of FabAV used to obtain initial control was 6 vials (range: 4 - 18 vials). Nine patients had severe venom effects that persisted despite FabAV therapy. Recurrent and/or delayed-onset severe defibrination syndrome occurred in 12 patients, most of whom did not receive recommended maintenance FabAV dosing. No patient developed systemic bleeding.

CONCLUSION

In this structured literature review, FabAV appears to be effective in the management of severe crotaline snake envenomation. Incomplete response to therapy, recurrence of venom effects, and delayed-onset venom effects were reported in case reports, but not reported in cohort studies.

Authors+Show Affiliations

Rocky Mountain Poison & Drug Center, Denver Health Hospital Authority, 777 Bannock St, MC 0180, Denver, CO 80204, USA. eric.lavonas@rmpdc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19545426

Citation

Lavonas, Eric J., et al. "Crotaline Fab Antivenom Appears to Be Effective in Cases of Severe North American Pit Viper Envenomation: an Integrative Review." BMC Emergency Medicine, vol. 9, 2009, p. 13.
Lavonas EJ, Schaeffer TH, Kokko J, et al. Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: an integrative review. BMC Emerg Med. 2009;9:13.
Lavonas, E. J., Schaeffer, T. H., Kokko, J., Mlynarchek, S. L., & Bogdan, G. M. (2009). Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: an integrative review. BMC Emergency Medicine, 9, 13. https://doi.org/10.1186/1471-227X-9-13
Lavonas EJ, et al. Crotaline Fab Antivenom Appears to Be Effective in Cases of Severe North American Pit Viper Envenomation: an Integrative Review. BMC Emerg Med. 2009 Jun 22;9:13. PubMed PMID: 19545426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: an integrative review. AU - Lavonas,Eric J, AU - Schaeffer,Tammi H, AU - Kokko,Jamie, AU - Mlynarchek,Sara L, AU - Bogdan,Gregory M, Y1 - 2009/06/22/ PY - 2009/02/24/received PY - 2009/06/22/accepted PY - 2009/6/24/entrez PY - 2009/6/24/pubmed PY - 2009/10/14/medline SP - 13 EP - 13 JF - BMC emergency medicine JO - BMC Emerg Med VL - 9 N2 - BACKGROUND: In 2000, the United States Food and Drug Administration approved Crotalidae Polyvalent Immune Fab (Ovine) (hereafter, FabAV), "for the management of patients with minimal to moderate North American Crotalid envenomation." Because whole-IgG pit viper antivenom is no longer available in the United States, FabAV is currently the only specific treatment option available to United States clinicians treating snakebite victims of any severity. No clinical trial data are available concerning the effectiveness of FabAV for treatment of severe snakebite, but several published articles describe its use in this setting. METHODS: We performed a comprehensive review of the English-language medical literature to identify all publications (1996 to July, 2008) containing data about the administration of FabAV. Two trained reviewers separately extracted case-level data concerning the administration of FabAV to patients with severe envenomation by North American crotaline snakes to a standardized form. Descriptive statistics were used. In addition, we hand-searched the US National Poison Data System reports for the years 2000-2006 to identify and describe any reports of death that occurred after FabAV administration. RESULTS: The literature review found 147 unique publications regarding FabAV. Twenty-four evaluable cases of severe human envenomation treated with FabAV were identified in 19 publications. Seven cases were described in five cohort studies, and 17 cases were described in 14 single patient case reports or non-cohort case series. Sixty-five specific severe venom effects were reported in these 24 patients, of which 50 effects (77%) improved or resolved after FabAV therapy. Initial control of all severe venom effects was achieved in 12 patients (50%). The rate at which initial control was achieved was significantly higher among patients reported in the cohort series than in the case series and non-cohort reports (100% vs. 29%, P = 0.005). The median dose of FabAV used to obtain initial control was 6 vials (range: 4 - 18 vials). Nine patients had severe venom effects that persisted despite FabAV therapy. Recurrent and/or delayed-onset severe defibrination syndrome occurred in 12 patients, most of whom did not receive recommended maintenance FabAV dosing. No patient developed systemic bleeding. CONCLUSION: In this structured literature review, FabAV appears to be effective in the management of severe crotaline snake envenomation. Incomplete response to therapy, recurrence of venom effects, and delayed-onset venom effects were reported in case reports, but not reported in cohort studies. SN - 1471-227X UR - https://www.unboundmedicine.com/medline/citation/19545426/Crotaline_Fab_antivenom_appears_to_be_effective_in_cases_of_severe_North_American_pit_viper_envenomation:_an_integrative_review_ L2 - https://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-9-13 DB - PRIME DP - Unbound Medicine ER -