A randomized blinded clinical trial of two antivenoms, prepared by caprylic acid or ammonium sulphate fractionation of IgG, in Bothrops and Porthidium snake bites in Colombia: correlation between safety and biochemical characteristics of antivenoms.

Otero, R; Gutiérrez, J M; Rojas, G; Núñez, V; Díaz, A; Miranda, E; Uribe, A F; Silva, J F; Ospina, J G; Medina, Y; Toro, M F; García, M E; León, G; García, M; Lizano, S; De La Torre, J; Márquez, J; Mena, Y; González, N; Arenas, L C; Puzón, A; Blanco, N; Sierra, A; Espinal, M E; Lozano, R

Otero, R; Gutiérrez, J M; Rojas, G; Núñez, V; Díaz, A; Miranda, E; Uribe, A F; Silva, J F; Ospina, J G; Medina, Y; Toro, M F; García, M E; León, G; García, M; Lizano, S; De La Torre, J; Márquez, J; Mena, Y; González, N; Arenas, L C; Puzón, A; Blanco, N; Sierra, A; Espinal, M E; Lozano, R.

Afiliação

Otero R; Centro de Investigaciones Médicas, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Toxicon ; 37(6): 895-908, 1999 Jun.

Article em En | MEDLINE | ID: mdl-10340829

RESUMO

A randomized blinded clinical trial was performed in 53 patients bitten by Bothrops sp. and Porthidium sp. in Antioquia and Chocó, Colombia, in order to compare the efficacy and safety of two antivenoms made of whole IgG obtained by either ammonium sulphate (monovalent anti-B. atrox) or caprylic acid (polyvalent) fractionation. Additionally, antivenoms were compared by electrophoretic and chromatographic analyses and anticomplementary activity in vitro. With a protocol of 2, 4 and 6 antivenom vials for the treatment of mild, moderate and severe envenomings, respectively, both antivenoms were equally efficient to neutralize the most relevant signs of envenoming and to clear serum venom levels in patients from the first hour and later on. Three patients with severe envenoming and initially treated with less than six vials on admission had persistent or recurrent venom antigenemia within 12-48 h. Monovalent antivenom fractionated by ammonium sulphate precipitation had higher amounts of protein aggregates and nonimmunoglobulin proteins than polyvalent antivenom fractionated by caprylic acid precipitation. Both antivenoms presented anticomplementary activity in vitro, being higher in the monovalent product. In agreement, monovalent antivenom induced a significantly higher incidence of early antivenom reactions (52%) than polyvalent antivenom (25%).

Assuntos

Antivenenos/uso terapêutico; Bothrops; Venenos de Crotalídeos/imunologia; Imunoglobulina G/uso terapêutico; Mordeduras de Serpentes/terapia; Adolescente; Adulto; Idoso; Sulfato de Amônio/química; Animais; Antivenenos/efeitos adversos; Antivenenos/isolamento & purificação; Caprilatos/química; Fracionamento Químico/métodos; Criança; Pré-Escolar; Colômbia; Método Duplo-Cego; Cavalos; Humanos; Imunoglobulina G/efeitos adversos; Imunoglobulina G/isolamento & purificação; Lactente; Pessoa de Meia-Idade; Segurança; Resultado do Tratamento

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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Mordeduras de Serpentes / Imunoglobulina G / Antivenenos / Bothrops / Venenos de Crotalídeos Tipo de estudo: Clinical_trials / Guideline Limite: Adolescent / Adult / Aged / Animals / Child / Child, preschool / Humans / Infant / Middle aged País/Região como assunto: America do sul / Colombia Idioma: En Revista: Toxicon Ano de publicação: 1999 Tipo de documento: Article País de afiliação: Colômbia País de publicação: Reino Unido

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