Para resumir uma longa historia, e para ilustrar essa postagem, segue-se correspondência pessoal com Dr. Warrel de hoje, 04 de março de 2011. É tema de interesse público, daí sua divulgação. Em 17/02/11 relatei estar colaborando com revisão do Manual do Ministério da Saúde para Animais Peçonhentos, e estar posicionando-me CONTRA o uso rotineiro de prometazina e hidrocortisona pré-soroterapia.
Ao consultar talvez aquele que seja o mais experiente entre nós, recebo resposta clara e objetiva. Com sua licença Professor:
Nucleo Serra Grande
|De:||David Warrell (firstname.lastname@example.org ...)|
|Enviada:||sexta-feira, 4 de março de 2011 14:40:49|
|Para:||Rodrigo C. G. Souza (email@example.com)|
Abaixo novamente Warrel, em correspondência pessoal, agora sobre corticoides pré-soroterapia. De novo o interesse público que me permite a divulgação. Com sua licença Professor:
"I disagree with the routine use of "high-dosage cortisone" before antivenom. Early reactions occur in less than a quarter of the patients and so it seems unreasonable to expose all to the general dangers of corticosteroids and possibly to increased venom toxicity. Corticosteroids are not always successful in preventing early serum reactions, but these reactions can be safely and effectively treated with adrenaline, 0 5 ml of 0 1°% solution by subcutaneous injection. The incidence of reactions due to anticomplementary activity may be reduced by diluting the antivenom and by giving it by slow intravenous infusion"
DAVID A WARRELL
Warrell, D A, et al, American Journal of Tropical
Medicine and Hygiene, 1976, 25, 517.
Warrell, D A, et al, British Medical Journal, 1975,
Theakston, R D G, and Reid, H A, Lancet, 1976,
Warrell, D A, and Ormerod, L D, American_Journal of
Tropical Medicine and Hygiene, 1976, 25, 525.
Abaixo outros dois trabalhos que ilustram a ineficácia do tratamento profilático de reações adversas na soroterapia:
Prevention of acute adverse reactions to snake antivenom after snakebite: multi-centre, randomized, controlled clinical trial
de Silva HA, Pathmeswaran A, Jayamanne S, Ariyasena H, Ratnatilaka GA, Kalupahana R, Uluwatte W, Ranasinha CD, Armitage J*, Aronson JK*, Lalloo DG**, de Silva HJ
Clinical Trials Unit, University of Kelaniya, Sri Lanka, *University of Oxford, and **Liverpool School of Tropical Medicine, UK.
Background: Polyvalent antivenom (PAV) is the most effective treatment for snakebite envenoming. Acute adverse reactions to the PAV are common; anaphylactic reactions are particularly serious.
Objective: To determine whether promethazine, hydrocortisone, and low-dose adrenaline, alone and in all possible combinations, prevent reactions to antivenom.
Methods: The study was conducted in 3 hospitals in Sri Lanka from March 2005 to April 2008. It required 1000 patients to detect a 25% reduction in reactions at p<0.01 with 80% power. After informed consent, patients were randomized in a 2x2x2 factorial blinded design to receive each active intervention versus matching placebo immediately before administration of PAV. They were monitored for adverse reactions categorized as mild, moderate, severe, for at least 96 hours. The pre-specified primary analyses were of effects of each intervention on the incidence of severe reactions over 48 hours.
Results: Of 1007 randomised subjects 776 (77.2%) were males, mean (sd) age 36.5 (13.6) yrs. Median time between snakebite and PAV administration was 4.25 hours. 752 (75%) patients developed acute reactions to PAV; 9% mild, 48% moderate, 43% severe. None of the drugs significantly reduced severe reactions to PAV at any time point. There was an 18.4% reduction in the rate of severe reactions at 1 hour with adrenaline (p=0.052), and a 33.3% reduction in signs of allergy (pruritus, urticaria, facial oedema, bronchospasm) with promethazine at 1 and 24 hours ( p<0.001).
Conclusions: Pre-treatment with promethazine, hydrocortisone, and low-dose adrenaline alone and in different combinations do not significantly reduce acute reactions to PAV.
BMJ 1999; 318 : 1451 (Published 29 May 1999)
Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites
- Hui Wen Fan, doctor (firstname.lastname@example.org)a,
- Luiz F Marcopito, associate professorb,
- João Luiz C Cardoso, doctora,
- Francisco O S França, doctora,
- Ceila M S Malaque, doctora,
- Ronnei A Ferrari, doctora,
- Robert David G Theakston, associate professorc,
- David A Warrell, associate professor
- a Hospital Vital Brazil, Instituto Butantan, Avenue Vital Brazil 1500, 05503-900, São Paulo, Brazil
- b Division of Epidemiology, Escola Paulista de Medicina, Unifesp, 04039-032, São Paulo, Brazil
- c Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA
- d Centre for Tropical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU
- Correspondence to: Dr H W Fan
Mestre Abade em quadro anafilático pós soroterapia anti laquética. Ficou no exantema. A adrenalina deteve a reação.
COM RELAÇÃO AO USO DE HEPARINA EM OFIDISMO, CONFIRA: