Routine antibiotic therapy in the management of the local inflammatory swelling in venomous snakebites: results of a placebo-controlled study.

OBJECTIVE: To evaluate the value of routine antibiotic therapy in the management of the local swelling of patients with venomous snakebites. METHODS: A prospective, placebo-controlled study at the General Hospital, Anuradhapura, Sri Lanka where 144 patients with envenoming and local swelling in the leg were allocated to receive either antibiotics (Group A = test group) or placebo (Group B = controls). Benzyl penicillin 2 mega units intravenously 6 hourly and metronidazole 500 mg by intravenous infusion 8 hourly for 5 days from the first day of the bite were given to Group A. Ethical committee approval was obtained from the Committee of General Hospital, Anuradhapura. MAIN OUTCOME MEASURES: Circumference difference between the affected limb and the normal limb, length of the swelling measured in centimetres, and the physical characteristics of the local swelling of both groups were compared. RESULTS: Group A had 69 patients and the Group B 75. The mean circumference difference (MCD) of the leg between the groups showed no significant difference for 4 days (P > 0.05), except at the site of the bite on the third day when the Group B showed a significant improvement (p = 0.02). There was no significant difference in the length of the local swelling or the score of physical characteristics between the two groups (P > 0.05). The proportions of recovery of the local swelling on the fourth and fifth day had no significant difference between the groups (P > 0.05). CONCLUSION: The routine use of antibiotics (penicillin and metronidazole) does not seem to be of value in reducing the local inflammatory swelling in venomous snakebite.

Epidemiology, clinical features, laboratory investigations and early diagnosis of dengue fever in adults: a descriptive study in Sri Lanka.

A descriptive observational study was conducted to identify the epidemiology, clinical features, laboratory investigations and markers for early diagnosis of acute dengue virus infection in adults. We enrolled 404 patients over a period of two years, beginning from 2001, at the Teaching Hospital Peradeniya, Sri Lanka. Based on serology, 239 patients were grouped as: IgM 43 (18%), IgG and IgM 140 (58%), and IgG 28 (12%). The clinically diagnosed group without serology numbered 165 patients. Most of the parameters between groups showed a similar pattern: mean age of 30 years, mean duration of fever 7 days (range 1-19 days). Mean total white blood cell and platelet counts started to fall from the second day of fever, with the lowest counts on the 5th to 7th days. Packed cell volume (PCV) showed minimum fluctuation. One hundred and sixty (88%) patients showed elevated liver enzymes (ALT and AST), with 122 of them having a two-fold increase. Three patients died, and complications such as myocarditis, large effusions, encephalopathy, acute renal failure, acute liver failure and diarrhea were observed. These results suggest that a combination of clinical picture, thrombocytopenia, leukopenia and elevated liver enzymes could be used as markers for early diagnosis of dengue infection. Furthermore, evidence-based guidelines should be developed for managing dengue infection in adults.