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A double‐blind, randomized trial of intravenous versus intramuscular antivenom for Red‐back spider envenoming
Author(s) -
Ellis Rodney M,
Sprivulis Peter C,
Jelinek George A,
Banham Neil DG,
Wood Simon V,
Wilkes Garry J,
Siegmund Andrew,
Roberts Brigit L
Publication year - 2005
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2005.00720.x
Subject(s) - medicine , antivenom , randomized controlled trial , double blind , anesthesia , spider , double blinded , surgery , venom , placebo , ecology , zoology , alternative medicine , pathology , biology
Objective: To compare the efficacy of intravenous versus intramuscular antivenom (AV) in the treatment of Red‐back spider (RBS) envenoming. Methods: Randomized, double‐dummy, double‐blind, multicentre trial of patients with red‐back spider envenoming requiring AV treatment recruited from five hospital EDs in Western Australia. Results: Thirty‐five patients were recruited; two were excluded; 33 were available for initial analysis, but two who were unblinded after one ampoule of trial AV and given i.v. AV had limited data; 31 remained in the study and had more complete data. After AV, pain scores for both i.m. and i.v. groups improved rapidly. At 24 h, the i.v. group was better with a 55% absolute difference (76% vs. 21%; 95% CI 25–85% difference) in the proportion pain‐free. There were no safety issues. Conclusions: Red‐back spider antivenom was initially effective by both i.m. and i.v. routes. The study generates the hypothesis that at 24 h, significantly more patients are pain‐free with i.v. administration. Definitive recommendations on the optimal route of administration of RBS AV await the results of further studies.