{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:47:45Z","timestamp":1790628465451,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"7475","license":[{"start":{"date-parts":[[2004,11,11]],"date-time":"2004-11-11T00:00:00Z","timestamp":1100131200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[2004,11,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective<\/jats:bold>\n                    To compare the efficacy and safety of three polyspecific antivenoms for bites by pit vipers.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design<\/jats:bold>\n                    Randomised double blind comparative trial of three antivenoms.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting<\/jats:bold>\n                    Shell, Pastaza, southeastern Ecuador.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Participants<\/jats:bold>\n                    210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Intervention<\/jats:bold>\n                    One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures<\/jats:bold>\n                    Permanent restoration of blood coagulability after 6 and 24 hours.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by\n                    <jats:italic>Bothrops atrox<\/jats:italic>\n                    , 68 (36%) by\n                    <jats:italic>B bilineatus<\/jats:italic>\n                    , and 10 (5%) by\n                    <jats:italic>B taeniatus, B brazili<\/jats:italic>\n                    , or\n                    <jats:italic>Lachesis muta<\/jats:italic>\n                    . Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in &gt; 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), &lt; 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46\/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of &lt; 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P &lt; 0.0001) but only three reactions were severe and none was fatal.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions<\/jats:bold>\n                    All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern.\n                  <\/jats:p>","DOI":"10.1136\/bmj.329.7475.1129","type":"journal-article","created":{"date-parts":[[2004,11,11]],"date-time":"2004-11-11T19:20:39Z","timestamp":1100200839000},"page":"1129","source":"Crossref","is-referenced-by-count":85,"title":["Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms"],"prefix":"10.1136","volume":"329","author":[{"given":"Roger","family":"Smalligan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Cole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narcissa","family":"Brito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin D","family":"Laing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce L","family":"Mertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Manock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Maudlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad","family":"Quist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Holland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G","family":"Lalloo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Rivadeneira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Barragan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Dolley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Eddleston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Warrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R David G","family":"Theakston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2004,11,11]]},"reference":[{"key":"2025122514562880000_329.7475.1129.1","first-page":"35","article-title":"Snake bite mortality in the world","volume":"10","author":"Swaroop","year":"1954","journal-title":"Bull World Health Org"},{"key":"2025122514562880000_329.7475.1129.2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.4269\/ajtmh.1991.44.93","article-title":"Venomous snakebite in eastern Ecuador","volume":"44","author":"Kerrigan","year":"1991","journal-title":"Am J Trop Med Hyg"},{"key":"2025122514562880000_329.7475.1129.3","first-page":"163","article-title":"Mordeduras de ofidios venenosos en la comunidad de los indigenas Siona-Secoya de San Pablo de Kantesyia y datos sobre la fauna de reptiles y anfibios locales","volume":"5","author":"Touzet","year":"1986","journal-title":"Publicaciones Museo Ecuatoriano de Ciencias Naturales"},{"key":"2025122514562880000_329.7475.1129.4","first-page":"709","article-title":"Snakebites in Central and South America: epidemiology, clinical features, and clinical management","volume-title":"The venomous reptiles of the western hemisphere","volume":"2","author":"Warrell","year":"2004"},{"key":"2025122514562880000_329.7475.1129.5","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(95)90105-1"},{"key":"2025122514562880000_329.7475.1129.6","unstructured":"Campbell JA Lamar WW . 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