(20) SNAKE BITE ASSOCIATED COMPLICATIONS AND SAFETY PROFILE OF ANTI-SNAKE VENOM - A SYSTEMATIC REVIEW AND META-ANALYSIS

Presenting Author(s)

AC

Ayyappa C. Chagi (he/him/his)

Pharm D Intern
Manipal Academy of Higher Education
Manipal, Karnataka, India

Author(s)

Girish Thunga P, PhD

Associate Professor
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education
Manipal, Karnataka, India
SR

Suhita Ramadugula

Trainee
Manipal Academy of Higher Education, India
IB

Izwath Begum

Trainee
Manipal Academy of Higher Education, India
AR

Asha K. Rajan, PharmD

Research Scholar
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal
Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education
Manipal, Karnataka, India
MR

Muhammed Rashid, MPharm (he/him/his)

Research Scholar
Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal
Manipal, Karnataka, India
VP

Viji P. Pulikkel Chandran, M.Pharm

Research Scholar
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Manipal, Karnataka, India
PG

Pooja G. Gopal Poojari, M Pharm

Research Scholar
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education
Manipal, Karnataka, India
RK

Raveena Kantamneni

Trainee
Manipal Academy of Higher Education, India
SS

Sanjana Shastri

Trainee
Manipal Academy of Higher Education, India
Sreedharan Nair, MPharm, PhD, PhD

Associate Professor
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal
Manipal, Karnataka, India

ABSTRACT: Background and objective: Snakebite Envenomation is a neglected tropical disease that can have fatal side effects. The complications associated with snake bites can have long-term hospitalization and increased healthcare costs. Anti-snake venom (ASV) is the main treatment strategy to overcome the complications and associated morbidity and mortality with venomous snake bites. This systematic review and meta-analysis aimed to identify the complications related to snake bites and ASV-associated adverse effects.

Methodology: The study protocol is registered in the PROSPERO- International prospective register of systematic reviews with a registration number CRD42020208908. The databases, such as PubMed, Scopus, and Cochrane, were searched from inception till December 2021. The key terms included in our study are ‘snake bite,’ ‘systematic review,’ ‘meta-analysis,’ ‘complications,’ ‘anti-snake venom,’ and ‘adverse drug reaction (ADR).’ The bibliographic search of included studies was performed with study selection criteria of English language, observational (prospective, ambispective, or retrospective case-control, cohort or cross-sectional) and randomized controlled trials (RCTs) reporting complications, management of snakebite and ADRs due to ASV. Neurotoxic and hemotoxic complications from venomous snakes, efficacy and ADRs of ASV have been considered in our study. The Cochrane risk of bias assessment and STROBE checklist was used to assess the quality of trials and observational studies.

Results: A total of 271 out of 9711 studies were included for systematic review and 175 studies for meta-analysis. Worldwide, Asian countries contributed significant cases, including India (48) and Sri Lanka (30) are major. Viperidae envenomation (66.43% [62 to 70.86]; n=73) was most prevalent compared to Elapidae and Colubridae. The most frequent complications are Acute kidney injury (46%), respiratory problems (26%), hypotension (19%), and shock (18%). Coagulation disorders and respiratory paralysis were the highest prevailing hemotoxic and neurotoxic complications, respectively. ADRs from ASV had early anaphylaxis reactions (14%), commonly presenting in the forms of urticaria (7%) and rash (6%). Management of snakebite victims included ASV (149%), which was the primary management. The fragment antibodies (F(ab’)₂) anti-venom significantly reduced 81% of the recurrent coagulopathy [OR: 0.19; 95%CI: 0.07 to 0.51; n=4] compared to the others. Overall, randomized controlled trials (RCT) and observational studies showed moderate to high quality. The highest score was 22, reported by three studies that were satisfactory for Strengthening the reporting of observational studies in epidemiology (STROBE) quality assessment.

Conclusion: Viperidae envenomation was the most prevailing snakebite. In-hospital adverse effects (pyrogenic and anaphylaxis) were prominent in ASV, which could be controlled by appropriate management strategies. Gathering the available evidence will help in the prediction of patients who are susceptible to ADRs. Further research should be focused on the efficacy and safety of ASVs and the development of region-specific management guidelines for snakebite envenomation.