OBJECTIVE: To investigate the efficacy of continuous infusion of hydrocortisone with or without chlorpheniramine bolus against early adverse reactions to polyspecific antivenom. DESIGN AND SETTING: Prospective, double-blind, randomised, placebo-controlled trial at General Hospital, Anuradhapura, Sri Lanka. SUBJECTS:52 patients with snake envenoming were randomised to receive infusion of hydrocortisone (Group A), hydrocortisone with chlorpheniramine bolus (Group B) or placebo (Group C) during the administration of antivenom. INTERVENTION: Hydrocortisone 1000 mg in 300 mL of normal saline infusion was started 5 min before and continued for 30 min after antivenom. Chlorpheniramine 10 mg intravenous bolus dose was given 5 min after commencement of antivenom. MAIN OUTCOME MEASURES: Occurrence and severity of adverse reactions to antivenom. RESULTS:Adverse reactions were observed in 80% (12/15) of Group A, 52% (11/21) of Group B, and 81% (13/16) of Group C. Reactions were mild or moderate except in two patients. A significant reduction in the number of adverse reactions was seen in Group B compared with the placebo group (difference, 29 percentage points; 95% CI, 0.2 to 58 percentage points). There was no significant difference between Group A and the placebo group. CONCLUSION: Prophylaxis with a parallel hydrocortisone infusion alone is ineffective in reducing the occurrence of acute adverse reaction to antivenom serum, but combining it with chlorpheniramine seems efficacious.
RCT Entities:
OBJECTIVE: To investigate the efficacy of continuous infusion of hydrocortisone with or without chlorpheniramine bolus against early adverse reactions to polyspecific antivenom. DESIGN AND SETTING: Prospective, double-blind, randomised, placebo-controlled trial at General Hospital, Anuradhapura, Sri Lanka. SUBJECTS: 52 patients with snake envenoming were randomised to receive infusion of hydrocortisone (Group A), hydrocortisone with chlorpheniramine bolus (Group B) or placebo (Group C) during the administration of antivenom. INTERVENTION: Hydrocortisone 1000 mg in 300 mL of normal saline infusion was started 5 min before and continued for 30 min after antivenom. Chlorpheniramine 10 mg intravenous bolus dose was given 5 min after commencement of antivenom. MAIN OUTCOME MEASURES: Occurrence and severity of adverse reactions to antivenom. RESULTS: Adverse reactions were observed in 80% (12/15) of Group A, 52% (11/21) of Group B, and 81% (13/16) of Group C. Reactions were mild or moderate except in two patients. A significant reduction in the number of adverse reactions was seen in Group B compared with the placebo group (difference, 29 percentage points; 95% CI, 0.2 to 58 percentage points). There was no significant difference between Group A and the placebo group. CONCLUSION: Prophylaxis with a parallel hydrocortisone infusion alone is ineffective in reducing the occurrence of acute adverse reaction to antivenom serum, but combining it with chlorpheniramine seems efficacious.
Authors: Geoffrey K Isbister; Kalana Maduwage; Ana Saiao; Nicholas A Buckley; Shaluka F Jayamanne; Shahmy Seyed; Fahim Mohamed; Umesh Chathuranga; Alexandre Mendes; Chandana Abeysinghe; Harindra Karunathilake; Indika Gawarammana; David G Lalloo; H Janaka de Silva Journal: PLoS Negl Trop Dis Date: 2015-07-02
Authors: H Asita de Silva; Arunasalam Pathmeswaran; Channa D Ranasinha; Shaluka Jayamanne; Senarath B Samarakoon; Ariyasena Hittharage; Ranjith Kalupahana; G Asoka Ratnatilaka; Wimalasiri Uluwatthage; Jeffrey K Aronson; Jane M Armitage; David G Lalloo; H Janaka de Silva Journal: PLoS Med Date: 2011-05-10 Impact factor: 11.069
Authors: Michael Eddleston; Nilantha Udayakumara; Sriyantha Adhikari; Dhamika de Silva; M H Rezvi Sheriff; Dhananjaya L Waidyaratne Journal: PLoS One Date: 2007-07-11 Impact factor: 3.240
Authors: Shelley F Stone; Geoffrey K Isbister; Seyed Shahmy; Fahim Mohamed; Chandana Abeysinghe; Harendra Karunathilake; Ariaranee Ariaratnam; Tamara E Jacoby-Alner; Claire L Cotterell; Simon G A Brown Journal: PLoS Negl Trop Dis Date: 2013-07-25