Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-Analysis
Objective. Pretreatment with hydrocortisone (prehydrocortisone) has been used to protect against adverse drug reactions (ADRs) following antivenom administration after snakebite. However, controversial results have been reported in studies evaluating its efficacy. Herein, we conducted a meta-analysi...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2022/6151206 |
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| author | Jihua Feng Zimeng Wu Qiao Yu Hongyuan Li Pan Ji Yanli Yang Xiaoliang Zeng Xiaowen Zheng Chunling Zhao Jianfeng Zhang |
| author_facet | Jihua Feng Zimeng Wu Qiao Yu Hongyuan Li Pan Ji Yanli Yang Xiaoliang Zeng Xiaowen Zheng Chunling Zhao Jianfeng Zhang |
| author_sort | Jihua Feng |
| collection | DOAJ |
| description | Objective. Pretreatment with hydrocortisone (prehydrocortisone) has been used to protect against adverse drug reactions (ADRs) following antivenom administration after snakebite. However, controversial results have been reported in studies evaluating its efficacy. Herein, we conducted a meta-analysis to evaluate the effect of prehydrocortisone on the risk of ADRs. Methods. We conducted a systematic search of PubMed, Embase, and Cochrane for relevant studies on the literature published up to December 6, 2020, with no language restrictions. Premedications, including hydrocortisone with or without other drugs, were compared with placebo or no premedication. Our primary end point was the risk of ADRs, which was reported as the number of patients who developed ADRs divided by the total number of snakebite patients administered with antivenom separately for the prehydrocortisone and control groups for each study. We evaluated pooled data using of a random-effects model. Results. Among 831 identified studies, 4 were eligible and included in our analysis (N = 1348 participants). Upon combining all eight comparisons from the four selected studies, the overall pooled odds ratio (OR) for ADRs was 0.47 (95% CI 0.19, 1.17; p=0.11; I2 = 68%). When the analysis was restricted to only articles using hydrocortisone with other drugs, the pooled OR was 0.19 (95% CI 0.05, 0.75; p=0.02; I2 = 55%). The result was not statistically significant when the analysis was restricted to studies using prehydrocortisone alone, or randomized controlled designs, or cohorts. Our study was limited by heterogeneity, quality, and a paucity of data. Conclusions. The findings in this study revealed that prehydrocortisone alone was ineffective. However, the substantial beneficial effect of prehydrocortisone combinations with premedications (injectable antihistamines or adrenaline) used against ADRs cannot be excluded. Therefore, the use of prehydrocortisone combinations with premedications (injectable antihistamines or adrenaline) as a prophylaxis may reduce the ADRs to antivenom. |
| format | Article |
| id | doaj-art-c4f732bf4dd44c49a6a228113849f92f |
| institution | Kabale University |
| issn | 2090-2859 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-c4f732bf4dd44c49a6a228113849f92f2025-02-03T01:08:47ZengWileyEmergency Medicine International2090-28592022-01-01202210.1155/2022/6151206Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-AnalysisJihua Feng0Zimeng Wu1Qiao Yu2Hongyuan Li3Pan Ji4Yanli Yang5Xiaoliang Zeng6Xiaowen Zheng7Chunling Zhao8Jianfeng Zhang9Department of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineObjective. Pretreatment with hydrocortisone (prehydrocortisone) has been used to protect against adverse drug reactions (ADRs) following antivenom administration after snakebite. However, controversial results have been reported in studies evaluating its efficacy. Herein, we conducted a meta-analysis to evaluate the effect of prehydrocortisone on the risk of ADRs. Methods. We conducted a systematic search of PubMed, Embase, and Cochrane for relevant studies on the literature published up to December 6, 2020, with no language restrictions. Premedications, including hydrocortisone with or without other drugs, were compared with placebo or no premedication. Our primary end point was the risk of ADRs, which was reported as the number of patients who developed ADRs divided by the total number of snakebite patients administered with antivenom separately for the prehydrocortisone and control groups for each study. We evaluated pooled data using of a random-effects model. Results. Among 831 identified studies, 4 were eligible and included in our analysis (N = 1348 participants). Upon combining all eight comparisons from the four selected studies, the overall pooled odds ratio (OR) for ADRs was 0.47 (95% CI 0.19, 1.17; p=0.11; I2 = 68%). When the analysis was restricted to only articles using hydrocortisone with other drugs, the pooled OR was 0.19 (95% CI 0.05, 0.75; p=0.02; I2 = 55%). The result was not statistically significant when the analysis was restricted to studies using prehydrocortisone alone, or randomized controlled designs, or cohorts. Our study was limited by heterogeneity, quality, and a paucity of data. Conclusions. The findings in this study revealed that prehydrocortisone alone was ineffective. However, the substantial beneficial effect of prehydrocortisone combinations with premedications (injectable antihistamines or adrenaline) used against ADRs cannot be excluded. Therefore, the use of prehydrocortisone combinations with premedications (injectable antihistamines or adrenaline) as a prophylaxis may reduce the ADRs to antivenom.http://dx.doi.org/10.1155/2022/6151206 |
| spellingShingle | Jihua Feng Zimeng Wu Qiao Yu Hongyuan Li Pan Ji Yanli Yang Xiaoliang Zeng Xiaowen Zheng Chunling Zhao Jianfeng Zhang Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-Analysis Emergency Medicine International |
| title | Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-Analysis |
| title_full | Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-Analysis |
| title_fullStr | Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-Analysis |
| title_full_unstemmed | Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-Analysis |
| title_short | Hydrocortisone for Preventing Adverse Drug Reactions to Snake Antivenom: A Meta-Analysis |
| title_sort | hydrocortisone for preventing adverse drug reactions to snake antivenom a meta analysis |
| url | http://dx.doi.org/10.1155/2022/6151206 |
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