Redback Spider Antivenom Evaluation II Study (RAVE II Study)

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Redback spider bites are common in Australia and red back spider envenoming (latrodectism) is the commonest significant envenoming in Australia. Redback spider antivenom (RBS AV) is the most frequently used antivenom in Australia. An estimated 5000 redback spider bites are treated with antivenom each year requiring a median of 2 vials of redback spider antivenom and an emergency department or hospital admission. We estimate this costs between $200,000 and $500,000 annually for antivenom and an equivalent amount in hospital costs. Early adverse reactions occur in approximately 4% of cases (40 to 120 patients annually) causing additional risk to the patient and costs to the health care system. Redback antivenom treatment therefore carries a considerable cost and measureable risk. However, despite the wide use of RBS AV and the clinical impression that it is effective, it has never been tested in a placebo randomized controlled trial. The results from our recent randomised controlled trial of intravenous versus intramuscular administration of redback spider antivenom (RAVE I) raise questions about the effectiveness of the antivenom. It is therefore essential to determine whether RBS AV is effective and justifies the costs and risks associated with its use. We propose to determine the effectiveness of RBS AV in a multicentre randomised placebo-controlled trial.

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