Antivenom for critically ill children with neurotoxicity from scorpion stings

Leslie V Boyer, Andreas A Theodorou, Robert A. Berg, Joanne Mallie, Ariana Chávez-Méndez, Walter García-Ubbelohde, Stephen Hardiman, Alejandro Alagón

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Clinically significant scorpion envenomation by Centruroides sculpturatus produces a dramatic neuromotor syndrome and respiratory insufficiency that often necessitate intensive supportive care. We hypothesized that a scorpion-specific F(ab′)2 antivenom would promptly resolve clinical symptoms in children with this syndrome. METHODS: In a randomized, double-blind study, the efficacy of scorpion-specific F(ab′)2 antivenom, as compared with placebo, was assessed in 15 children 6 months to 18 years of age who were admitted to a pediatric intensive care unit with clinically significant signs of scorpion envenomation. The primary end point was the resolution of the clinical syndrome within 4 hours after administration of the study drug. Secondary end points included the total dose of concomitant midazolam for sedation and quantitative plasma venom levels, before and after treatment. RESULTS: The clinical syndrome resolved more rapidly among recipients of the antivenom than among recipients of placebo, with a resolution of symptoms in all eight antivenom recipients versus one of seven placebo recipients within 4 hours after treatment (P = 0.001). More midazolam was administered in the placebo recipients than in the antivenom recipients (mean cumulative dose, 4.61 vs. 0.07 mg per kilogram of body weight; P = 0.01). Plasma venom concentrations were undetectable in all eight antivenom recipients but in only one placebo recipient 1 hour after treatment (P = 0.001). CONCLUSIONS: Among critically ill children with neurotoxic effects of scorpion envenomation, intravenous administration of scorpion-specific F(ab′) 2 antivenom resolved the clinical syndrome within 4 hours, reduced the need for concomitant sedation with midazolam, and reduced the levels of circulating unbound venom. (ClinicalTrials.gov number, NCT00685230.)

Original languageEnglish (US)
Pages (from-to)2090-2098
Number of pages9
JournalNew England Journal of Medicine
Volume360
Issue number20
DOIs
StatePublished - May 14 2009

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Scorpion Stings
Antivenins
Scorpions
Critical Illness
Placebos
Midazolam
Venoms
Pediatric Intensive Care Units
Critical Care
Double-Blind Method
Respiratory Insufficiency
Intravenous Administration
Therapeutics
Body Weight

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Boyer, L. V., Theodorou, A. A., Berg, R. A., Mallie, J., Chávez-Méndez, A., García-Ubbelohde, W., ... Alagón, A. (2009). Antivenom for critically ill children with neurotoxicity from scorpion stings. New England Journal of Medicine, 360(20), 2090-2098. https://doi.org/10.1056/NEJMoa0808455

Antivenom for critically ill children with neurotoxicity from scorpion stings. / Boyer, Leslie V; Theodorou, Andreas A; Berg, Robert A.; Mallie, Joanne; Chávez-Méndez, Ariana; García-Ubbelohde, Walter; Hardiman, Stephen; Alagón, Alejandro.

In: New England Journal of Medicine, Vol. 360, No. 20, 14.05.2009, p. 2090-2098.

Research output: Contribution to journalArticle

Boyer, LV, Theodorou, AA, Berg, RA, Mallie, J, Chávez-Méndez, A, García-Ubbelohde, W, Hardiman, S & Alagón, A 2009, 'Antivenom for critically ill children with neurotoxicity from scorpion stings', New England Journal of Medicine, vol. 360, no. 20, pp. 2090-2098. https://doi.org/10.1056/NEJMoa0808455
Boyer, Leslie V ; Theodorou, Andreas A ; Berg, Robert A. ; Mallie, Joanne ; Chávez-Méndez, Ariana ; García-Ubbelohde, Walter ; Hardiman, Stephen ; Alagón, Alejandro. / Antivenom for critically ill children with neurotoxicity from scorpion stings. In: New England Journal of Medicine. 2009 ; Vol. 360, No. 20. pp. 2090-2098.
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AU - Boyer, Leslie V

AU - Theodorou, Andreas A

AU - Berg, Robert A.

AU - Mallie, Joanne

AU - Chávez-Méndez, Ariana

AU - García-Ubbelohde, Walter

AU - Hardiman, Stephen

AU - Alagón, Alejandro

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N2 - BACKGROUND: Clinically significant scorpion envenomation by Centruroides sculpturatus produces a dramatic neuromotor syndrome and respiratory insufficiency that often necessitate intensive supportive care. We hypothesized that a scorpion-specific F(ab′)2 antivenom would promptly resolve clinical symptoms in children with this syndrome. METHODS: In a randomized, double-blind study, the efficacy of scorpion-specific F(ab′)2 antivenom, as compared with placebo, was assessed in 15 children 6 months to 18 years of age who were admitted to a pediatric intensive care unit with clinically significant signs of scorpion envenomation. The primary end point was the resolution of the clinical syndrome within 4 hours after administration of the study drug. Secondary end points included the total dose of concomitant midazolam for sedation and quantitative plasma venom levels, before and after treatment. RESULTS: The clinical syndrome resolved more rapidly among recipients of the antivenom than among recipients of placebo, with a resolution of symptoms in all eight antivenom recipients versus one of seven placebo recipients within 4 hours after treatment (P = 0.001). More midazolam was administered in the placebo recipients than in the antivenom recipients (mean cumulative dose, 4.61 vs. 0.07 mg per kilogram of body weight; P = 0.01). Plasma venom concentrations were undetectable in all eight antivenom recipients but in only one placebo recipient 1 hour after treatment (P = 0.001). CONCLUSIONS: Among critically ill children with neurotoxic effects of scorpion envenomation, intravenous administration of scorpion-specific F(ab′) 2 antivenom resolved the clinical syndrome within 4 hours, reduced the need for concomitant sedation with midazolam, and reduced the levels of circulating unbound venom. (ClinicalTrials.gov number, NCT00685230.)

AB - BACKGROUND: Clinically significant scorpion envenomation by Centruroides sculpturatus produces a dramatic neuromotor syndrome and respiratory insufficiency that often necessitate intensive supportive care. We hypothesized that a scorpion-specific F(ab′)2 antivenom would promptly resolve clinical symptoms in children with this syndrome. METHODS: In a randomized, double-blind study, the efficacy of scorpion-specific F(ab′)2 antivenom, as compared with placebo, was assessed in 15 children 6 months to 18 years of age who were admitted to a pediatric intensive care unit with clinically significant signs of scorpion envenomation. The primary end point was the resolution of the clinical syndrome within 4 hours after administration of the study drug. Secondary end points included the total dose of concomitant midazolam for sedation and quantitative plasma venom levels, before and after treatment. RESULTS: The clinical syndrome resolved more rapidly among recipients of the antivenom than among recipients of placebo, with a resolution of symptoms in all eight antivenom recipients versus one of seven placebo recipients within 4 hours after treatment (P = 0.001). More midazolam was administered in the placebo recipients than in the antivenom recipients (mean cumulative dose, 4.61 vs. 0.07 mg per kilogram of body weight; P = 0.01). Plasma venom concentrations were undetectable in all eight antivenom recipients but in only one placebo recipient 1 hour after treatment (P = 0.001). CONCLUSIONS: Among critically ill children with neurotoxic effects of scorpion envenomation, intravenous administration of scorpion-specific F(ab′) 2 antivenom resolved the clinical syndrome within 4 hours, reduced the need for concomitant sedation with midazolam, and reduced the levels of circulating unbound venom. (ClinicalTrials.gov number, NCT00685230.)

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