Why do antivenoms still terrify Brazilian doctors? Lessons from the penicillin treatment decentralization.

Wuelton Monteiro, Adele Schwartz Benzaken, Fan Hui Wen
Author Information
  1. Wuelton Monteiro: School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil; Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. Electronic address: wueltonmm@gmail.com.
  2. Adele Schwartz Benzaken: School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil; Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; AIDS Healthcare Foundation Global Program, Los Angeles, USA.
  3. Fan Hui Wen: School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil; Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Bioindustrial Center, Fundação Butantan, São Paulo, Brazil.

Abstract

Penicillin and antivenom treatments may cause early adverse reactions. Given the low incidence of hypersensitivity reactions attributed to penicillin, the Brazilian Ministry of Health determined the decentralization of the use of this medicine to community health centers, especially to treat syphilis and prophylaxis of congenital syphilis. Regarding antivenoms, the establishment of modern purification technologies in the manufacturing process ensured the increasing efficacy and safety in the country. However, lack of training and the use of outdated evidence on the frequency of adverse reactions and the overdiagnosis of hypersensitivity reactions to antivenoms generates resistance from health professionals to administer these products in non-hospital settings. Also, robust studies on the safety of concomitant medications are lacking in this field. This results in delays in treatment leading to poor clinical outcomes.

Keywords

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