A Controlled Clinical Trial on The Use of a Specific Antivenom Against Envenoming by Bungarus Multicinctus

NCT ID: NCT00811239

Last Updated: 2008-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1/PHASE2

Total Enrollment

81 participants

Study Classification

INTERVENTIONAL

Study Start Date

2004-03-31

Study Completion Date

2006-12-31

Brief Summary

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In northern Vietnam, a vast majority of the most severe envenomed patients are bitten by Bungarus multicinctus. Hitherto, these victims have received supportive care only. The aims of this study were to assess the possible efficacy and side effects of a newly produced antivenom.

Detailed Description

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Venomous snakebites constitute a serious health problem in many Asian countries. In Vietnam, the burden of snakebite on the public health stimulated Calmette to conduct original studies at the Vaccine Institute in Saigon over a hundred years ago and to develop the first snake antivenom ever.

In northern Vietnam, a vast majority of the most severe envenomed patients are bitten by Bungarus multicinctus, which is the only krait species giving rise to significant morbidity and mortality in the area. Its venom contains toxins which can cause severe neuromuscular blockade but which do not give rise to swelling or necrosis at the site of the bite.

Supportive care is an important part of the management of snakebites, but antivenom administration is the mainstay therapy in the majority of medically significant envenomings. Such specific therapy may dramatically reduce the consequences of the envenomation. In Vietnam, no specific antivenom against B. multicinctus has been available until recently when it has produced for clinical use.

Conditions

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Snake Bite

Keywords

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antivenom snake bite Bungarus multicinctus Vietnam

Study Design

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Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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control group

As the antivenom was not yet clinically available until 2006, all patients included during the first two years (2004-2005) received supportive therapy only.

Group Type OTHER

Supportive Care

Intervention Type OTHER

Supportive Care only (endotracheal intubation, mechanical ventilation...)

antivenom group

The patients included during the third year (2006) were treated with antivenom therapy and supportive care.

Group Type ACTIVE_COMPARATOR

Bungarus multicinctus-candidus Antivenom

Intervention Type DRUG

Five to ten ampoules of antivenom, depending on severity of muscle paralysis, were diluted with isotonic glucose solution to have total 50 ml and infused intravenously by electric pump during one hour. After a period of 6-8 hours, a second infusion was administered, under similar condition to the first, if no clinical improvement or adverse reaction had been noted. The patients also received supportive care such as intubation, ventilation...if necessary.

Interventions

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Bungarus multicinctus-candidus Antivenom

Five to ten ampoules of antivenom, depending on severity of muscle paralysis, were diluted with isotonic glucose solution to have total 50 ml and infused intravenously by electric pump during one hour. After a period of 6-8 hours, a second infusion was administered, under similar condition to the first, if no clinical improvement or adverse reaction had been noted. The patients also received supportive care such as intubation, ventilation...if necessary.

Intervention Type DRUG

Supportive Care

Supportive Care only (endotracheal intubation, mechanical ventilation...)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Envenomed by B. multicinctus
* Showed clinical signs of systemic envenomation (neuromuscular signs)
* Provided written informed consent (during the year 2006)

Exclusion Criteria

* Pregnancy
* Patients had a known history of intolerance to equine serum
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Karolinska Institutet

OTHER

Sponsor Role collaborator

Swedish International Development Cooperation Agency (SIDA)

OTHER_GOV

Sponsor Role collaborator

Hanoi Medical University

OTHER

Sponsor Role lead

Principal Investigators

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Jonas Höjer, MD, PhD

Role: STUDY_DIRECTOR

Karorinska Institute, Swedish Poisons Information Centre

Locations

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Vietnam Poison Control Center, Bach Mai Hospital, HMU

Hanoi, , Vietnam

Site Status

Countries

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Vietnam

References

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Chan JC, Cockram CS, Buckley T, Young K, Kay R, Tomlinson B. Evenoming by Bungarus multicinctus (many-banded krait) in Hong Kong. J Trop Med Hyg. 1995 Dec;98(6):457-60.

Reference Type RESULT
PMID: 8544231 (View on PubMed)

Pe T, Myint T, Htut A, Htut T, Myint AA, Aung NN. Envenoming by Chinese krait (Bungarus multicinctus) and banded krait (B. fasciatus) in Myanmar. Trans R Soc Trop Med Hyg. 1997 Nov-Dec;91(6):686-8. doi: 10.1016/s0035-9203(97)90524-1.

Reference Type RESULT
PMID: 9509180 (View on PubMed)

Cheng AC, Winkel KD. Snakebite and antivenoms in the Asia-Pacific: wokabaut wantaim, raka hebou ("walking together"). Med J Aust. 2001 Dec 3-17;175(11-12):648-51. doi: 10.5694/j.1326-5377.2001.tb143762.x. No abstract available.

Reference Type RESULT
PMID: 11837876 (View on PubMed)

Dart RC, McNally J. Efficacy, safety, and use of snake antivenoms in the United States. Ann Emerg Med. 2001 Feb;37(2):181-8. doi: 10.1067/mem.2001.113372.

Reference Type RESULT
PMID: 11174237 (View on PubMed)

White J. Envenoming and antivenom use in Australia. Toxicon. 1998 Nov;36(11):1483-92. doi: 10.1016/s0041-0101(98)00138-x.

Reference Type RESULT
PMID: 9792162 (View on PubMed)

Karlson-Stiber C, Persson H, Heath A, Smith D, al-Abdulla IH, Sjostrom L. First clinical experiences with specific sheep Fab fragments in snake bite. Report of a multicentre study of Vipera berus envenoming. J Intern Med. 1997 Jan;241(1):53-8. doi: 10.1046/j.1365-2796.1997.80896000.x.

Reference Type RESULT
PMID: 9042094 (View on PubMed)

Ha TH, Hojer J, Trinh XK, Nguyen TD. A controlled clinical trial of a novel antivenom in patients envenomed by Bungarus multicinctus. J Med Toxicol. 2010 Dec;6(4):393-7. doi: 10.1007/s13181-010-0051-4.

Reference Type DERIVED
PMID: 20358414 (View on PubMed)

Other Identifiers

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second study on snakebite

Identifier Type: -

Identifier Source: secondary_id

antivenom

Identifier Type: -

Identifier Source: org_study_id