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A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan Russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study.

Abstract
Russell's viper is the most important cause of life-threatening snake bite and acute renal failure in Sri Lanka. Only equine polyspecific antivenoms imported from India are available. They have not proved effective clinically or in clearing venom antigenemia and they frequently cause reactions. In an attempt to reduce mortality and morbidity, a new monospecific ovine Fab fragment antivenom (PolongaTab; Therapeutic Antibodies, Inc., London, United Kingdom) was raised against Sri Lankan Russell's viper venom. In a preliminary dose-finding study in 35 patients, an initial dose of 3-4 g restored blood coagulability permanently and stopped systemic bleeding, even in severely envenomed patients. Venom antigenemia disappeared within 1 hr of antivenom treatment but recurred, probably as a result of continued absorption of venom from the site of the bite, after the rapid clearance of therapeutic antibody. Twelve patients (34%) experienced early reactions that were usually mild and always responded to epinephrine.
AuthorsC A Ariaratnam, W P Meyer, G Perera, M Eddleston, S A Kuleratne, W Attapattu, R Sheriff, A M Richards, R D Theakston, D A Warrell
JournalThe American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 61 Issue 2 Pg. 259-65 (Aug 1999) ISSN: 0002-9637 [Print] UNITED STATES
PMID10463677 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antivenins
  • Immunoglobulin Fab Fragments
  • Viper Venoms
  • Epinephrine
Topics
  • Adolescent
  • Adult
  • Animals
  • Antivenins (administration & dosage, adverse effects, immunology)
  • Child
  • Dose-Response Relationship, Drug
  • Epinephrine (therapeutic use)
  • Female
  • Humans
  • Immunoglobulin Fab Fragments (pharmacology)
  • Lethal Dose 50
  • Male
  • Mice
  • Middle Aged
  • Pharmacokinetics
  • Russell's Viper
  • Snake Bites (physiopathology, therapy)
  • Sri Lanka
  • Treatment Outcome
  • Viper Venoms (blood, pharmacokinetics)

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