Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite - 25/08/11
, Charles J Gerardo, MD b, Gerald O'Malley, DO c, Thomas C Arnold, MD d, Sean P Bush, MD e, William Banner, MD, PhD f, Mark Steffens, MD, MS g, William P Kerns, MD a
Address for correspondence: Eric Lavonas, MD, Department of Emergency Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232-2861Abstract |
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.
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 | Author contributions: EJL coordinated data collection and analysis and wrote the initial drafts of the manuscript. EJL, CJG, MS, and WPK submitted cases that were included in the final version. All authors participated in revision of the manuscript. EJL takes responsibility for the paper as a whole. Presented in part at the North American Congress of Clinical Toxicology, Palm Springs, CA, September 29, 2002. This study was produced without benefit of grant and was not funded by the manufacturer of any product involved. Dr. Bush and Dr. Arnold are paid participants in an advisory panel for Savage Laboratories, Melville, NY. Reprints not available from the authors. |
Vol 43 - N° 2
P. 200-206 - février 2004 Retour au numéro
Article précédent
- Exposure to extremely high concentrations of carbon dioxide : A clinical description of a mass casualty incident
- Pinchas Halpern, Yosef Raskin, Patrick Sorkine, Arthur Oganezov
- Copperhead bites and Crotalidae polyvalent immune Fab (ovine) : Routine use requires evidence of improved outcomes
- E.Martin Caravati
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