Effect of pre-medication on early adverse reactions following antivenom use in snakebite: a systematic review and meta-analysis
Abstract
BACKGROUND: Pre-medication has been used to protect against early adverse reactions (EAR) following antivenom administration after snakebite. Studies have evaluated its efficacy with variable results.
OBJECTIVE: The aim of the study was to conduct a systematic review and meta-analysis of published data to assess the effect of pre-medication on the risk of EAR.
METHODS: We conducted a search of MEDLINE, the Cochrane Database and various search engines/websites, searched handbooks, book chapters and peer-reviewed articles relating to clinical snakebite, and consulted experts in this field. The search was on published literature up to September 2010. A meta-analysis was conducted of all randomized and non-randomized studies of EAR following antivenom in snakebite that utilized either adrenaline (epinephrine)-containing or non-adrenaline (antihistamines, corticosteroids)-containing pre-medications compared with control groups. We performed either random- or fixed-effects analysis based on the presence of heterogeneity as assessed with two tests, including the I2 statistic, and performed restricted analyses on data derived from randomized or non-randomized studies. Sensitivity analysis investigating the influence of single studies on overall estimates was conducted and we determined publication bias where detected in both of the two tests used for its assessment.
RESULTS: Three randomized and four non-randomized studies were selected for inclusion in this study. When all ten…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 434 participants or records.
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