The effect of pre-hospital care for venomous snake bite on outcome in Nigeria

Nabeel

Archives of Disease in Childhood

et al. 2013

Objectives To evaluate clinical outcome and factors affecting outcome in children with snake envenomation. Design Prospective observational study. Setting Paediatric intensive care unit of a tertiary care teaching hospital in India. Patients We prospectively enrolled children ≤12 years of age admitted to our hospital with a definitive history of snake bite from August 2007 to June 2010. Measurements and Main Results Demographic characteristics and clinical course of the enrolled children were recorded in a structured proforma and analysed using appropriate statistical methods. Children were treated as per the WHO guidelines (2005) on the management of snake bite in children. Of 110 children studied, 77 (69%) were male. Most (72; 64.2%) had features predominantly of haematotoxic envenomation while 20 (18%) and 18 (16%) children had features of neurotoxic envenomation and local involvement, respectively. 14 children (13%) died and 13 (12%) had major disabilities. On univariable analysis, the following prehospital and admission variables were found to be significantly associated with poor outcome: age, walking for >1 km after the bite, vomiting, haemoglobin ≤10 g/dl at admission and species of snake (cobra). On multivariable analysis, only younger age (adjusted OR 0.85; 95% CI 0.7 to 0.9), walking for >1 km after the bite (adjusted OR 57; 95% CI 4.2 to 782) and haemoglobin ≤10 g/dl at admission (adjusted OR 6; 95% CI 2 to 18.2) remained significant. Conclusions Younger age at presentation, anaemia (haemoglobin ≤10 g/dl) and distance walked after the bite may be independent predictors of mortality and morbidity in children with snake bite. These features in victims of snake bite warrant early referral to and management in tertiary care centres.

Section: Discussionmentioning

confidence: 99%

Factors affecting outcome in children with snake envenomation: a prospective observational study

Nabeel

Archives of Disease in Childhood

et al. 2013

“…It was suggested that secondary bacterial infections from snakebites are related to the oral and fangs microbiota of the perpetrating snake [20–26]. Besides, traditional treatment also contributes for the emergence of secondary infections, such as tourniquet use, local alternative medicines, incision and suction of the bite site [8,18,27]. These factors increase the development of expressive forms of secondary infection, which has been primarily diagnosed with identification of cellulitis or abscesses [12,13,22].…”

Section: Introductionmentioning

confidence: 99%

“…For example, ampicillin/cephalosporin/cloxacillin [14,27], ciprofloxacin [15,22] and clindamycin [36,38,39] were previously used for secondary bacterial infections resulted from snakebites, with variable effectiveness. In the Amazon, basic information about the bacterial agents responsible by the wound infection is still lacking since secondary infection diagnosis is mostly based only from clinical features without microbiological confirmation.…”

Section: Introductionmentioning

confidence: 99%

Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: A randomized controlled clinical trial

et al. 2017

BackgroundSecondary bacterial infections from snakebites contribute to the high complication rates that can lead to permanent function loss and disabilities. Although common in endemic areas, routine empirical prophylactic use of antibiotics aiming to prevent secondary infection lacks a clearly defined policy. The aim of this work was to estimate the efficacy of amoxicillin clavulanate for reducing the secondary infection incidence in patients bitten by Bothrops snakes, and, secondarily, identify risk factors for secondary infections from snakebites in the Western Brazilian Amazon.Methods and findingsThis was an open-label, two-arm individually randomized superiority trial to prevent secondary infection from Bothrops snakebites. The antibiotic chosen for this clinical trial was oral amoxicillin clavulanate per seven days compared to no intervention. A total of 345 patients were assessed for eligibility in the study period. From this total, 187 accomplished the inclusion criteria and were randomized, 93 in the interventional group and 94 in the untreated control group. All randomized participants completed the 7 days follow-up period. Enzyme immunoassay confirmed Bothrops envenoming diagnosis in all participants. Primary outcome was defined as secondary infection (abscess and/or cellulitis) until day 7 after admission. Secondary infection incidence until 7 days after admission was 35.5% in the intervention group and 44.1% in the control group [RR = 0.80 (95%CI = 0.56 to 1.15; p = 0.235)]. Survival analysis demonstrated that the time from patient admission to the onset of secondary infection was not different between amoxicillin clavulanate treated and control group (Log-rank = 2.23; p = 0.789).Secondary infections incidence in 7 days of follow-up was independently associated to fibrinogen >400 mg/dL [AOR = 4.78 (95%CI = 2.17 to 10.55; p<0.001)], alanine transaminase >44 IU/L [AOR = 2.52 (95%CI = 1.06 to 5.98; p = 0.037)], C-reactive protein >6.5 mg/L [AOR = 2.98 (95%CI = 1.40 to 6.35; p = 0.005)], moderate pain [AOR = 24.30 (95%CI = 4.69 to 125.84; p<0.001)] and moderate snakebites [AOR = 2.43 (95%CI = 1.07 to 5.50; p = 0.034)].Conclusions/SignificancePreemptive amoxicillin clavulanate was not effective for preventing secondary infections from Bothrops snakebites. Laboratorial markers, such as high fibrinogen, alanine transaminase and C-reactive protein levels, and severity clinical grading of snakebites, may help to accurately diagnose secondary infections.Trial registrationBrazilian Clinical Trials Registry (ReBec): RBR-3h33wy; UTN Number: U1111-1169-1005.

J. Toxicol. Environ. Health Sci.

“…The use of traditional healing methods after a snakebite, before seeking professional treatment, is common in Bangladesh (86% by statistics) , Nigeria (81%) (Michael et al, 2011), Pakistan (75%) (Chandio et al, 2000), Kenya (68%) (Snow et al, 1994), India (74%) (Hati et al, 1992) and 61% (Inamdar et al, 2010), and Nepal (22%) (Sharma et al, 2004a), (56%) (Pandey, 2007) and (26%) (Pandey et al, 2010a). In Nepal, snakebite victims in many cases still use various dangerous and useless first aid measures.…”

Section: Introductionmentioning

confidence: 99%

Inclusion of incorrect information on snakebite first aid in school and university teaching materials in Nepal

P¹

2013

In previous studies in Nepal, snakebite victims were found to either not have Pressure Immobilization Bandaging (PIB) or Local Compression Pad Immobilization (LCPI) performed for first aid, or had it performed incorrectly. The goal of this study was to evaluate training texts regarding first aid measures for snakebite and the rates of performance of both methods currently recommended, as well as ineffective or harmful practices. The study was conducted from September, 2009 to November, 2010. It evaluated the venomous snakebite first aid measures recommended in the 31 most recently published and commonly used Nepalese reference works and textbooks aimed at paramedical personnel, primary health care workers, medical undergraduates, and students of class five to bachelor´s degree. It compared the suggestions of these with those of published guidelines for the management of snakebite envenomation. Up to 100% of first aid measures advocated in these materials differed significantly from published guidelines. This included the omission of appropriate activities, misstatements and prescription of inappropriate treatments. Among appropriate recommendations that were missing was the advice to apply PIB or LCPI, and the suggestion to go to a snakebite treatment center. Fifty-five percent of the references did recommend emergency transport. Inclusion of accurate evidence-based information regarding first aid measures for venomous snakebite in commonly used texts could help to reduce the application of ineffective or harmful pre-hospital practices, their associated morbidity and mortality, and increase the use of appropriate methods.