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VOLUME 19 , ISSUE 6 ( 2015 ) > List of Articles


High-dose versus low-dose antivenom in the treatment of poisonous snake bites: A systematic review

Rashmi Ranjan Das, Jhuma Sankar, Nishanth Dev

Keywords : Clinical trials, evidence, snake anti-venom, snake bite

Citation Information : Das RR, Sankar J, Dev N. High-dose versus low-dose antivenom in the treatment of poisonous snake bites: A systematic review. Indian J Crit Care Med 2015; 19 (6):340-349.

DOI: 10.4103/0972-5229.158275

License: CC BY-ND 3.0

Published Online: 01-05-2016

Copyright Statement:  Copyright © 2015; The Author(s).


Though snake antivenom (SAV) is the mainstay of therapy for poisonous snake bites, there is no universally accepted standard regimen regarding the optimum dose (low vs. high). We therefore, undertook this systematic review to address this important research question. We searched all the published literature through the major electronic databases till August 2014. Randomized clinical trials (RCTs) were included. Eligible trials compared low versus high dose SAV in poisonous snake bite. The review has been registered at PROSPERO (Registration number: CRD42014009700). Of 36 citations retrieved, a total of 5 RCTs (n = 473) were included in the final analyses. Three trials were open-label, 4 conducted in Indian sub-continent and 1 in Brazil. The doses of SAV varied in the high dose group from 40 ml to 550 ml, and in the low dose group from 20 ml to 220 ml. There was no significant difference between the two groups for any of the outcomes except duration of hospital stay, which was lower in the low dose group. The GRADE evidence generated was of "very low quality." Low-dose SAV is equivalent or may be superior to high-dose SAV in management of poisonous snake bite. Low dose is also highly cost-effective as compared to the high dose. But the GRADE evidence generated was of "very low quality" as most were open label trials. Further trials are needed to make definitive recommendations regarding the dose and these should also include children <9 years of age.

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