RESUMO
OBJECTIVE: To compare the efficacy of intravenous versus intramuscular antivenom (AV) in the treatment of Red-back spider (RBS) envenoming. METHODS: Randomized, double-dummy, double-blind, multicentre trial of patients with red-back spider envenoming requiring AV treatment recruited from five hospital EDs in Western Australia. RESULTS: Thirty-five patients were recruited; two were excluded; 33 were available for initial analysis, but two who were unblinded after one ampoule of trial AV and given i.v. AV had limited data; 31 remained in the study and had more complete data. After AV, pain scores for both i.m. and i.v. groups improved rapidly. At 24 h, the i.v. group was better with a 55% absolute difference (76% vs. 21%; 95% CI 25-85% difference) in the proportion pain-free. There were no safety issues. CONCLUSIONS: Red-back spider antivenom was initially effective by both i.m. and i.v. routes. The study generates the hypothesis that at 24 h, significantly more patients are pain-free with i.v. administration. Definitive recommendations on the optimal route of administration of RBS AV await the results of further studies.
Assuntos
Antivenenos/administração & dosagem , Picada de Aranha/tratamento farmacológico , Venenos de Aranha/antagonistas & inibidores , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/tratamento farmacológico , Dor/etiologia , Medição da Dor , Picada de Aranha/complicações , Venenos de Aranha/efeitos adversos , Resultado do TratamentoRESUMO
Livedoid vasculopathy is a painful, ulcerating condition of the lower legs, ankles and feet with the typical histological feature of hyalinising vascular change of dermal blood vessels with minimal inflammation. Therapeutic interventions have been diverse and varyingly successful. We report a biopsy-proven case in a 27-year-old male, which responded rapidly and completely to hyperbaric oxygen therapy. A few such cases have been reported previously, but only in dermatological journals, not in the hyperbaric medicine literature.