Adjunct treatment in snakebite envenoming: a systematic review of randomised controlled trials

Serial evaluation of local changes in snakebite envenomation using infrared thermal imaging

BACKGROUND

There is a lack of objective tools to assess the local changes following snakebite envenomation. We aimed to describe the progression of local changes in envenomed patients using serial infrared thermal imaging.

METHODS

In a prospective sample of patients with snakebite envenomation, clinical assessment and infrared imaging of local changes were done at enrolment and 6 h and 24 h later, followed by once daily until hospital discharge or day 7, whichever was earlier. Infrared images were interpreted by an investigator masked to clinical findings.

RESULTS

We studied 39 patients with snakebite envenomation. Their mean age was 44.6±12.7 y and 25 (64%) were men. The median time to stability of local changes was 24.6 h (interquartile range [IQR] 17.0-30.1) on clinical examination and 28.0 h (IQR 13.7-55.2) on infrared imaging. At 24 h there was simple agreement between the two methods on whether the local changes were progressing or not in 31 of 39 patients (80%; Cohen's κ=0.59, p<0.001). The maximum proximal extent of local changes assessed using the two methods had a good correlation (Spearman's ρ=0.713, p<0.001). However, the extent of thermal changes on infrared images often exceeded the upper limit of swelling detected clinically.

CONCLUSIONS

Infrared imaging could be used to objectively document the local changes caused by snakebite envenomation.

Effects of heparin on venom-induced consumption coagulopathy: a meta-analysis of randomized controlled trials

Venom-induced consumption coagulopathy (VICC) is a serious complication of snakebites, potentially leading to life-threatening bleeding. Despite efforts to determine effective treatments other than antivenom, such as heparin, the evidence supporting their use remains insufficient. Therefore, this study aimed to perform a systematic review, meta-analysis and trial sequential analysis (TSA) to examine the effects of heparin on VICC. On 11 August 2024, a systematic search for randomized controlled trials (RCTs) investigating the effects of heparin on VICC was conducted using eight online databases. Six RCTs were included in this study. The meta-analysis revealed that heparin did not significantly reduce the mortality rate (risk ratio, 0.65; 95% CI 0.39 to 1.10). Additionally, the meta-analysis showed no significant differences in various clinical outcomes between the heparin group and control group. The TSA indicated insufficient evidence to conclude the effects of heparin on VICC mortality, and a sample size of 741 patients may be needed for further RCTs. In conclusion, our findings indicate that heparin may not significantly affect VICC outcomes. Although the current evidence is inconclusive because of the limited sample size, it highlights the need for future trials to provide more precise insights.

Lack of controlled studies on snakebite prevention: a rapid review

Globally, snakebites cause an estimated 80 000-140 000 deaths annually. While there are evidence-based recommendations for managing snakebite victims, recommendations on the prevention of snakebites are limited to expert opinions. We conducted a rapid review to summarise evidence from human studies with a control group on preventing snakebites. Searching PubMed, Web of Science, Scopus, CINAHL and EMBASE with inclusive search terms without language or time limits only yielded three eligible studies (one case control study and two prospective controlled clinical studies), highlighting a knowledge gap. Two studies in Nepal by the same group showed that health education of stakeholders and sleeping under a bednet can significantly reduce snakebite incidence (p<0.05), but these observations are not confirmed elsewhere, and because of the high risk of bias the certainty of evidence was low. The third study from Sri Lanka, which assessed if sleeping above ground would prevent snakebites, had inconclusive results. This demonstrates an urgent need for studies with a control group to guide evidence-based recommendations for snakebite prevention. Potential interventions tested can range from low-cost measures such as wearing appropriate footwear in resource-limited settings to testing the efficacy of chemical, biological (e.g. rodent control) or device-based methods and community-supported platforms tracking snakebite sightings with real-time geolocation data in highly resourced settings.

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia

Introduction

Millions of snake bites occur worldwide each year. Clinical practice guidelines generally do not recommend the use of prophylactic antibiotics.

Objective

To determine the sociodemographic, clinical, and pharmacological variables and the use of antibiotics in a group of patients with snake bites in Colombia.

Methods

A retrospective cross-sectional study was carried out. Patients affiliated with a Colombian health insurer who presented with snake bites between 2015 and 2022 were included. The cases were identified from the National Public Health Surveillance System. Sociodemographic, clinical and pharmacological variables were identified. Descriptive and bivariate analyses were performed.

Results

A total of 643 patients were analyzed, with a median age of 30.8 years, and 74.7% were men. The most frequently identified genus of snake was Bothrops (88.8%), and most incidents were classified as mild ophidian accidents (61.6%). A total of 59.7% of patients received snake antivenom. A total of 13.8% and 2.2% of the patients had cellulitis or abscesses, respectively. A total of 63.5% received antibiotics (50.6% for prophylaxis and 12.9% for treatment), especially cephalexin (25.9%), and most of the antibiotic management was considered inappropriate (91.7%).

Conclusion

Most patients with snake bites received antibiotics, especially for prophylactic purposes, a clinical behavior that goes against current evidence. The use of antibiotics with an unsuitable spectrum for the microorganisms that are usually found in the wounds of these patients is frequent. The development of local clinical practice guidelines is required to help reduce the overprescription of antibiotics, as the excessive use of antimicrobials is the main determinant of antimicrobial resistance.