Fan H W, Marcopito L F, Cardoso J L, França F O, Malaque C M, Ferrari R A, Theakston R D, Warrell D A
Hospital Vital Brazil, Instituto Butantan, Avenue Vital Brazil 1500, 05503-900, São Paulo, Brazil.
BMJ. 1999 May 29;318(7196):1451-2. doi: 10.1136/bmj.318.7196.1451.
To investigate the efficacy of the H1 antihistamine promethazine against early anaphylactic reactions to antivenom.
Sequential randomised, double blind, placebo controlled trial.
Public hospital in a venom research institute, São Paulo, Brazil.
101 patients requiring antivenom treatment after being bitten by bothrops snakes.
Intramuscular injection of promethazine (25 mg for adults and 0.5/kg for children) or placebo given 15-20 min before starting intravenous infusion of antivenom.
Incidence and severity of anaphylactic reactions occurring within 24 hours after antivenom.
Reactions occurred in 12 of 49 patients treated with promethazine (24%) and in 13 of 52 given placebo (25%); most were mild or moderate. Continuous sequential analysis indicated that the study could be interrupted at the 22nd untied pair, without preference for promethazine or placebo.
Prophylaxis with promethazine does not prevent early reactions. Patients should be observed carefully during antivenom infusion and the subsequent few hours.
研究H1抗组胺药异丙嗪对抗蛇毒血清早期过敏反应的疗效。
序贯随机、双盲、安慰剂对照试验。
巴西圣保罗一家毒液研究所的公立医院。
101名被具窍蝮蛇咬伤后需要抗蛇毒血清治疗的患者。
在开始静脉输注抗蛇毒血清前15 - 20分钟，肌肉注射异丙嗪（成人25毫克，儿童0.5毫克/千克）或安慰剂。
抗蛇毒血清后24小时内发生过敏反应的发生率和严重程度。
49名接受异丙嗪治疗的患者中有12名出现反应（24%），52名接受安慰剂治疗的患者中有13名出现反应（25%）；大多数反应为轻度或中度。连续序贯分析表明，该研究可在第22对配对时中断，对异丙嗪或安慰剂无偏好。
异丙嗪预防不能防止早期反应。在输注抗蛇毒血清期间及随后几小时应密切观察患者。
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