Redback spider bites in children in South Australia: A 10‐year review of antivenom effectiveness

Abstract

Objective: To describe the South Australian paediatric redback spider bite experience and to examine the hypothesis that redback antivenom (RBAV) treatment in children is clinically effective. Methods: Retrospective chart review of all children under 18 years of age presenting to the EDs of the three major paediatric or mixed hospitals in Adelaide, South Australia, with a discharge diagnosis of redback spider envenomation between 1 January 2010 and 31 March 2020. The main outcome measures include: patient and bite demographics; presenting symptoms and signs; treatment provided; clinical effects at 2 h post RBAV administration on pain, diaphoresis, blood pressure, heart rate and systemic features; overall clinical impression of RBAV effectiveness and resolution of symptoms prior to discharge. Results: There were 256 patient encounters involving 235 patients. Latrodectism was described in onethird (34%) of the cases. Sixty-one patients received RBAV and in 57 (93%) patients the RBAV had good clinical effect. Two hours post RBAV administration, pain resolved in 71%, hypertension resolved in 62%, diaphoresis resolved in 43% and tachycardia resolved in 82%. There were no cases of urticaria or anaphylaxis and one case of serum sickness. Conclusions: This retrospective review of redback spider envenomation in South Australian children over a 10-year period has demonstrated clinical effectiveness of RBAV in paediatric patients across all age groups, observed in both clinician perceived results and measurable outcomes. RBAV remains an effective treatment for redback envenomation in children.

Response to Re: Redback spider bites in children in South Australia: A 10‐year review of antivenom effectiveness

“…Response to Re: Redback spider bites in children in South Australia: A 10-year review of antivenom effectiveness Dear Editor, We thank Downes et al 1 for their comments regarding our paper. 2 We agree with their concern that the findings of our simple retrospective study have provided such contradictory results in comparison to the two prospective predominantly adultbased redback antivenom evaluation (RAVE) clinical trials. 3,4 We offer 'no plausible science' to explain these differences, as we recognise and have documented the limitations of our retrospective study and only suggest further prospective clinical trials in children to investigate this issue.…”

“…Previous research has shown that, in an unselected cohort of patients and in patients with chronic obstructive airways disease, venous values of pH are clinically interchangeable with arterial values while agreement of bicarbonate and lactate are close but less precise. 1,2 Agreement of pCO 2 is not clinically acceptable; however, it has been shown to be a good screening test for significant hypercapnia. 1,2 There is a gap in the literature regarding arteriovenous (AV) blood gas agreement in patients with severe pneumonia.…”

“…1,2 Agreement of pCO 2 is not clinically acceptable; however, it has been shown to be a good screening test for significant hypercapnia. 1,2 There is a gap in the literature regarding arteriovenous (AV) blood gas agreement in patients with severe pneumonia. The COVID-19 pandemic provided an opportunity to address this issue.…”

Re: Redback spider bites in children in South Australia: A 10‐year review of antivenom effectiveness

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Dear Editor, We read with concern the study by Cocks et al 1 which aims to evaluate the effectiveness of redback spider antivenom (RBSAV) using a retrospective, single arm methodology. This methodology is questionable in the context of existing clinical trials, which have demonstrated RBSAV to be no better than standard analgesia alone.

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“…However, ED length of stay data are not provided, which combined with a lack of follow up, make any meaningful interpretation of this difficult. 1 Pain is a significant and persistent problem in latrodectism potentially lasting up to 48 h, hence both RAVE and RAVE II randomised controlled trials reporting analgesic effect up to 24 h postadministration. 2,3 Cocks et al report 56 of 61 (92%) patients having a good response to RBSAV.…”