Non-venomous snakebites in the Western Brazilian Amazon

Silva, Ageane Mota da; Mendes, Viviane Kici da Graça; Monteiro, Wuelton Marcelo; Bernarde, Paulo Sérgio

doi:10.1590/0037-8682-0120-2019

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…In these cases, the mistaken administration of antivenom has no clinical benefit to the patient, but may still potentially lead to early or late adverse reactions. Inappropriate clinical judgements for antivenom treatment have been documented in several countries, leading to unnecessary antivenom usage ( Fung et al, 2009 ; da Silva et al, 2019b ). At the same time, more rational use has also been reported after implementation of new treatment protocols, notably in Bangladesh and India ( Harris et al, 2010 ; Ghosh et al, 2008 ).…”

Section: Downstream: Prescribing and Dispensing/usementioning

confidence: 99%

Access to antivenoms in the developing world: A multidisciplinary analysis

et al. 2021

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Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.

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Section: Downstream: Prescribing and Dispensing/usementioning

confidence: 99%

Access to antivenoms in the developing world: A multidisciplinary analysis

et al. 2021

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“…These cases are, however, poorly investigated. For instance, in the Brazilian Amazon, many snakebites are caused by snakes of no medical importance, as their bites only lead to minor trauma with or without fang marks [ 122 ]. If the clinical investigation is based only on the report of individuals who have had conditions of this severity during their lifetime, incorrect conclusions can easily be drawn.…”

Section: Clinical Features Of Dry Bites: To Treat or Not To Treat?mentioning

confidence: 99%

Current Knowledge on Snake Dry Bites

Pucca

Knudsen

Oliveira

et al. 2020

Toxins

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Snake ‘dry bites’ are characterized by the absence of venom being injected into the victim during a snakebite incident. The dry bite mechanism and diagnosis are quite complex, and the lack of envenoming symptoms in these cases may be misinterpreted as a miraculous treatment or as proof that the bite from the perpetrating snake species is rather harmless. The circumstances of dry bites and their clinical diagnosis are not well-explored in the literature, which may lead to ambiguity amongst treating personnel about whether antivenom is indicated or not. Here, the epidemiology and recorded history of dry bites are reviewed, and the clinical knowledge on the dry bite phenomenon is presented and discussed. Finally, this review proposes a diagnostic and therapeutic protocol to assist medical care after snake dry bites, aiming to improve patient outcomes.

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“…In Brazil, irrational use of antivenoms is common, with a high frequency of both over-and under-prescribing. Snakebites that do not require antivenom treatment, such as dry bites, in which no venom is injected [19], and bites caused by snakes of no medical importance [20], are common. For the professionals who participated in the study, however, these facts seemed new, as they did not know that there could be cases of snakebites that need only to be placed under observation, without any intervention except for wound care and the use of painkillers in some cases.…”

Section: Sbe Care Information Package Improving Rational Av Use and R...mentioning

confidence: 99%

Validation of a Culturally Relevant Snakebite Envenomation Clinical Practice Guideline in Brazil

Rocha

Farias

Alcântara

et al. 2022

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Snakebite envenoming (SBE) is a neglected tropical disease with significant global morbidity and mortality. Even when antivenom is available in low-resource areas, health workers do not receive adequate training to manage SBEs. This study aims to develop and validate a clinical practice guideline (CPG) for SBE management across Brazil. A panel of expert judges with academic and/or technical expertise in SBE management performed content validation. The content validity index (CVI) score was 90% for CPG objectives, 89% for structure and presentation and 92% for relevance and classified the CPG as valid. A semantic validation was performed by analyzing focus group discussions with doctors and nurses from three municipalities of the Brazilian Amazon, after a 5-day meeting during which the CPG was presented. Two central themes emerged: knowledge acquired during the meeting and recommendations for improving the CPG. Based on these results, the CPG was revised into a final version. This study presents the successful development and validation process of a CPG for SBE management, which is targeted to a specific low-resource, high-burden setting. This development and validation process can be adapted to other settings and/or other neglected tropical diseases.

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Non-venomous snakebites in the Western Brazilian Amazon

Cited by 14 publications

References 10 publications

Access to antivenoms in the developing world: A multidisciplinary analysis

Access to antivenoms in the developing world: A multidisciplinary analysis

Current Knowledge on Snake Dry Bites

Validation of a Culturally Relevant Snakebite Envenomation Clinical Practice Guideline in Brazil

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