Evidence behind the WHO Guidelines: Hospital Care for Children: Should s/c Adrenaline, Hydrocortisone or Antihistamines be used as Premedication for Snake Antivenom?

The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources, these can be found at; http://www.who.int/child-adolescent-health/publications/CHILD_HEALTH/PB.htm. This series reviews the scientific evidence behind WHO's recommendations. The WHO guidelines, and more reviews are available at www.ichrc.org. This review addresses the question: Should s/c adrenaline, hydrocortisone or antihistamines be used as premedication for snake antivenom? The WHO Pocketbook of Hospital Care for Children recommends that in the event antivenom is given for snakebite then IM epinephrine and IV chlorpheniramine should be prepared in case allergic reaction occurs. Managing snake envenomation is challenging throughout the world. Even though antivenom is highly effective in reducing serious complications and mortality [1, 2], its potential for severe anaphylactoid reactions calls for judicious use [3–5]. The frequency of acute reactions to antivenom varies between 2-54% [6, 7] and are responsive to administration of adrenaline [4–6, 8]. The late serum sickness-like reactions can occur in more than 50% of patients [4, 9] and are readily treated with steroids and antihistamines [5].