CHAPTER 88 CROFAB IN SNAKEBITES

A Randomized Multicenter Trial of Crotalinae Polyvalent Immune Fab (Ovine) Antivenom for the Treatment for Crotaline Snakebite in the United States

Dart RC, Seifert SA, Boyer LV, et al. Arch Intern Med. 2001;161(16):2030–2036

BACKGROUND

Out of the several thousand snakebite victims every year in the United States, approximately six die and an additional 15% to 40% suffer long-term complications of envenomation from minor limb disfiguration to coagulopathic and neurologic dysfunction. The previously available horse serum antivenom was effective against venomous Crotalidae bites but had several potential adverse effects such as acute hypersensitivity reactions (urticaria, hypotension, anaphylaxis) and delayed hypersensitivity reactions (serum sickness). A new ovine antivenom, Crotalinae polyvalent immune Fab (Fab AV) was shown to be safe and effective in a prospective open-label pilot trial involving 11 patients; however, local recurrence of limb swelling was observed in several patients, prompting this first randomized trial of antivenin in the United States.

OBJECTIVES

To compare the safety and efficacy of two dosing regimens of Crotalinae polyvalent immune Fab (Fab AV).

METHODS

Prospective, randomized, open-label comparative trial of two dosing regimens of Fab AV performed at seven sites in six US states between 1994 and 1996. A validated severity score was used to assess patient severity.

Participants

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