• 1.

    Peterson ME, Matz M, Seibold K, et al. A randomized multicenter trial of Crotalidae polyvalent immune F(ab) antivenom for the treatment of rattlesnake envenomation in dogs. J Vet Emerg Crit Care (San Antonio) 2011;21:335345.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Peterson ME. Snake bite: pit vipers. Clin Tech Small Anim Pract 2006;21:174182.

  • 3.

    The World Health Organization. Model Formulary 2008. Geneva: World Health Organization, 2009;396397.

  • 4. Silverstein DC, Hopper K. Small animal critical care medicine. St Louis: Saunders, 2015;915916.

  • 5.

    Gilliam LL, Brunker J. North American snake envenomation in the dog and cat. Vet Clin North Am Small Anim Pract 2011;41:12391259.

  • 6.

    Armentano RA, Schaer M. Overview and controversies in the medical management of pit viper envenomation in the dog. J Vet Emerg Crit Care (San Antonio) 2011;21:461470.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    World Health Organization. WHO guidelines for the production, control and regulation of snake antivenom immunoglobulins. World Health Organ Tech Rep Ser 2018;964:107157.

    • Search Google Scholar
    • Export Citation
  • 8.

    Johnson M. Antibody structure and antibody fragments. Mater Methods 2013;3:160.

  • 9.

    Lee BM, Zersen KM, Schissler JR, et al. Antivenin-associated serum sickness in a dog. J Vet Emerg Crit Care (San Antonio) 2019;29:558563.

  • 10.

    Rattler antivenin [package insert]. Ames, Iowa: Mg Biologics, 2016.

  • 11.

    Antivenin (Crotalidae) polyvalent [package insert]. St Joseph, Mo: Boehringer Ingelheim, 2011.

  • 12.

    Gutiérrez JM, Léon G, Lomonte B. Pharmacokinetic-pharmacodynamic relationships of immunoglobulin therapy for envenomation. Clin Pharmacokinet 2003;42:721741.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila) 2015;53:3745.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Woods C, Young D. Clinical safety evaluation of F(ab')2 anti-venom (Crotalus durissus-Bothrops asper) administration in dogs. J Vet Emerg Crit Care (San Antonio) 2011;21:565569.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Crofab Crotalidae polyvalent immune Fab (ovine) lyophilized powder for solution for intravenous injection [package insert]. West Conshohocken, Pa: BTG International Inc, 2017.

    • Search Google Scholar
    • Export Citation
  • 16.

    Antivipmyn Tri solution (injectable) [package insert]. Tlalpan, Mexico: Instituto Bioclon, 2016.

  • 17.

    VenomVet [package insert]. Canoga Park, Calif: MT Venom LLC, 2020.

  • 18.

    Coulter A, Harris R. Simplified preparation of rabbit fab fragments. J Immunol Methods 1983;59:199203.

  • 19.

    Russell FE, Ruzić N, Gonzalez H. Effectiveness of antivenin (Crotalidae) polyvalent following injection of Crotalus venom. Toxicon 1973;11:461464.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Theakston RD, Warrell DA, Griffiths E. Report of a WHO workshop on the standardization and control of antivenoms. Toxicon 2003;41:541557.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Laustsen AH, Gutiérrez JM, Knudsen C, et al. Pros and cons of different therapeutic antibody formats for recombinant antivenom development. Toxicon 2018;146:151175.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Brown DE, Meyer DJ, Wingfield WE, et al. Echinocytosis associated with rattlesnake envenomation in dogs. Vet Pathol 1994;31:654657.

  • 23.

    Lowe CH, Schwalbe CR, Johnson TB. The venomous reptiles of Arizona. Phoenix: Arizona Game and Fish, 1986;3076, 9598.

  • 24.

    Schaeffer TH, Khatri V, Reifler LM, et al. Incidence of immediate hypersensitivity reaction and serum sickness following administration of Crotalidae polyvalent immune Fab antivenom: a meta-analysis. Acad Emerg Med 2012;19:121131.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Consroe P, Gerrish K, Egen N, et al. Intravenous dose-lethality study of American pit viper venoms in mice using standardized methods. J Wilderness Med 1992;3:162167.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    McCown JL, Cooke KL, Hanel RM, et al. Effect on anti-venin dose on outcome from crotalid envenomation: 218 dogs (1988–2006). J Vet Emerg Crit Care (San Antonio) 2009;19:603610.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Katzenbach JE, Foy DS. Retrospective evaluation of the effect of antivenom administration on hospitalization duration and treatment cost for dogs envenomated by Crotalus viridis: 113 dogs (2004–2012). J Vet Emerg Crit Care (San Antonio) 2015;25:655659.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement

Retrospective comparison of three antivenoms for the treatment of dogs with crotalid envenomation

View More View Less
  • 1 From VCA Valley Animal Hospital and Emergency Center, Tucson, AZ 85711; and VCA Clinical Studies, Los Angeles, CA 90064.

Abstract

OBJECTIVE

To retrospectively compare clinical outcomes associated with 3 commercially available antivenom products (2 F[ab']2 products and 1 IgG product) in dogs with crotalid envenomation.

ANIMALS

282 dogs with evidence of crotalid envenomation treated with antivenom at a single high-volume private emergency facility in southwestern Arizona from 2014 to 2018.

PROCEDURES

Data were collected on all dogs regarding signalment, coagulation test results, snakebite characteristics, type and number of units of antivenom received (1 of 3 products), survival to hospital discharge (yes or no), and complications following discharge. Survival rates and other variables were compared among antivenoms by means of bivariable analyses.

RESULTS

271 of 282 (96.1%) dogs survived to discharge; 11 (3.9%) were euthanized or died in the hospital. No significant difference in survival rates was found among the 3 antivenom products. Infusion reaction rates were higher for the IgG product than for each F(ab')2 product. A higher percentage of dogs treated with the IgG product (vs either F[ab']2 product) received only 1 unit of antivenom. Variables associated with a lower probability of survival included older age and lower body weight, thoracic (vs other) location of snakebites, and presence of an antivenom infusion reaction.

CONCLUSIONS AND CLINICAL RELEVANCE

Given that survival rates were high for all 3 antivenom products, clinicians may consider other factors when selecting an antivenom, such as preference for a fractionated versus whole immunoglobulin product, risk of infusion reaction, cost, shelf life, availability, ease of use and administration, species of crotalids used for antivenom production, approval by federal regulatory bodies, and clinical preference.

Abstract

OBJECTIVE

To retrospectively compare clinical outcomes associated with 3 commercially available antivenom products (2 F[ab']2 products and 1 IgG product) in dogs with crotalid envenomation.

ANIMALS

282 dogs with evidence of crotalid envenomation treated with antivenom at a single high-volume private emergency facility in southwestern Arizona from 2014 to 2018.

PROCEDURES

Data were collected on all dogs regarding signalment, coagulation test results, snakebite characteristics, type and number of units of antivenom received (1 of 3 products), survival to hospital discharge (yes or no), and complications following discharge. Survival rates and other variables were compared among antivenoms by means of bivariable analyses.

RESULTS

271 of 282 (96.1%) dogs survived to discharge; 11 (3.9%) were euthanized or died in the hospital. No significant difference in survival rates was found among the 3 antivenom products. Infusion reaction rates were higher for the IgG product than for each F(ab')2 product. A higher percentage of dogs treated with the IgG product (vs either F[ab']2 product) received only 1 unit of antivenom. Variables associated with a lower probability of survival included older age and lower body weight, thoracic (vs other) location of snakebites, and presence of an antivenom infusion reaction.

CONCLUSIONS AND CLINICAL RELEVANCE

Given that survival rates were high for all 3 antivenom products, clinicians may consider other factors when selecting an antivenom, such as preference for a fractionated versus whole immunoglobulin product, risk of infusion reaction, cost, shelf life, availability, ease of use and administration, species of crotalids used for antivenom production, approval by federal regulatory bodies, and clinical preference.

Contributor Notes

Address correspondence to Dr. Carotenuto (sarah.carotenuto@vca.com).