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Antivenom efficacy or effectiveness: the Australian experience.
Toxicology. 2010 Feb 09; 268(3):148-54.T

Abstract

Despite widespread use of antivenoms, many questions remain about their effectiveness in the clinical setting. The almost universal acceptance of their value is based mainly on in vitro studies, animal studies and human observational studies. Numerous examples exist where they demonstrate clear benefit, such as consumption coagulopathy in viper envenoming, prevention of neurotoxicity in Australasian elapid bites, systemic effects in scorpion and funnel-web spider envenoming. There are also concerns about the quality and efficacy of some antivenoms. However, it is important not to confuse the efficacy of antivenom, defined as its ability to bind and neutralise venom-mediated effects under ideal conditions, and the effectiveness of antivenom, defined as its ability to reverse or prevent envenoming in human cases. There are numerous potential reasons for antivenom failure in human envenoming, of which antivenom inefficacy is only one. Other important reasons include venom-mediated effects being irreversible, antivenom being unable to reach the site of toxin-mediated injury, or the rapidity of onset of venom-mediated effects. A number of recent studies in Australia bring into question the effectiveness of some antivenoms, including snake antivenom for coagulopathy, redback spider and box jellyfish antivenoms. Despite brown snake antivenom being able to neutralise venom induced clotting in vitro, use of the antivenom in human envenoming does not appear to change the time course of coagulopathy. However, it is important that apparent antivenom ineffectiveness in specific cases is correctly interpreted and does not lead to a universal belief that antivenom is ineffective. It should rather encourage further studies to investigate the underlying pathophysiology of envenoming, the pharmacokinetics of venoms and antivenoms, and ultimately the effectiveness of antivenom based on snake type, clinical effects and timing of administration.

Authors+Show Affiliations

Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia. geoffrey.isbister@menzies.edu.au

Pub Type(s)

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

Language

eng

PubMed ID

19782716

Citation

Isbister, Geoffrey K.. "Antivenom Efficacy or Effectiveness: the Australian Experience." Toxicology, vol. 268, no. 3, 2010, pp. 148-54.
Isbister GK. Antivenom efficacy or effectiveness: the Australian experience. Toxicology. 2010;268(3):148-54.
Isbister, G. K. (2010). Antivenom efficacy or effectiveness: the Australian experience. Toxicology, 268(3), 148-54. https://doi.org/10.1016/j.tox.2009.09.013
Isbister GK. Antivenom Efficacy or Effectiveness: the Australian Experience. Toxicology. 2010 Feb 9;268(3):148-54. PubMed PMID: 19782716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antivenom efficacy or effectiveness: the Australian experience. A1 - Isbister,Geoffrey K, Y1 - 2009/09/25/ PY - 2009/05/28/received PY - 2009/09/19/revised PY - 2009/09/21/accepted PY - 2009/9/29/entrez PY - 2009/9/29/pubmed PY - 2010/3/17/medline SP - 148 EP - 54 JF - Toxicology JO - Toxicology VL - 268 IS - 3 N2 - Despite widespread use of antivenoms, many questions remain about their effectiveness in the clinical setting. The almost universal acceptance of their value is based mainly on in vitro studies, animal studies and human observational studies. Numerous examples exist where they demonstrate clear benefit, such as consumption coagulopathy in viper envenoming, prevention of neurotoxicity in Australasian elapid bites, systemic effects in scorpion and funnel-web spider envenoming. There are also concerns about the quality and efficacy of some antivenoms. However, it is important not to confuse the efficacy of antivenom, defined as its ability to bind and neutralise venom-mediated effects under ideal conditions, and the effectiveness of antivenom, defined as its ability to reverse or prevent envenoming in human cases. There are numerous potential reasons for antivenom failure in human envenoming, of which antivenom inefficacy is only one. Other important reasons include venom-mediated effects being irreversible, antivenom being unable to reach the site of toxin-mediated injury, or the rapidity of onset of venom-mediated effects. A number of recent studies in Australia bring into question the effectiveness of some antivenoms, including snake antivenom for coagulopathy, redback spider and box jellyfish antivenoms. Despite brown snake antivenom being able to neutralise venom induced clotting in vitro, use of the antivenom in human envenoming does not appear to change the time course of coagulopathy. However, it is important that apparent antivenom ineffectiveness in specific cases is correctly interpreted and does not lead to a universal belief that antivenom is ineffective. It should rather encourage further studies to investigate the underlying pathophysiology of envenoming, the pharmacokinetics of venoms and antivenoms, and ultimately the effectiveness of antivenom based on snake type, clinical effects and timing of administration. SN - 1879-3185 UR - https://www.unboundmedicine.com/medline/citation/19782716/Antivenom_efficacy_or_effectiveness:_the_Australian_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-483X(09)00486-7 DB - PRIME DP - Unbound Medicine ER -