Evidence behind the WHO guidelines: Hospital care for children: Should s/c adrenaline, hydrocortisone or antihistamines be used as premedication for snake antivenom?

Premedication with subcutaneous adrenaline is effective in reducing acute adverse reactions due to snake antivenom (Grade A recommendation). However, local factors and patient selection need to be considered carefully. There is no strong evidence to support the use of hydrocortisone as premedication for snake antivenom (Grade B recommendation). Current evidence does not support routine antihistamines use as premedication for snake antivenom (Grade A recommendation). Further studies are needed to verify effectiveness of combination therapy with hydrocortisone and antihistamines. Doses of sub-cutaneous adrenaline as pre-medication for younger children are yet to be evaluated in clinical trials, but fractional doses based on weight may be appropriate. © 2006 Oxford University Press.