Comparison of Different Dosing Protocols of Anti-Snake Venom (ASV) in Snake Bite Cases

Daswani, Bharti R.; Chandanwale, Ajay; Kadam, Deelip; Ghongane, Balasaheb B.; Ghorpade, Vishwajeet Sampatrao; Manu, H C

doi:10.7860/jcdr/2017/20132.10670

Cited by 11 publications

(12 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,12 BR Daswani et al found that lower doses of ASV are as effective as the conventional high dose without being associated with higher mortality or morbidity. 13 This was in conformity with our results. Study by Paul V et al reported that high doses of ASV, apart from being nonsuperior and more costly, may at times turn out to be more harmful.…”

Section: Discussionsupporting

confidence: 93%

A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation

Shekar

Soren

Reddy

et al. 2020

Int J Contemp Pediatr

View full text Add to dashboard Cite

Background: Every year about 50,000, people die of snake bites in India. Anti-snake venom and mechanical ventilation is mainstay of treatment in cases with severe neurotoxic envenomation. ASV is costly and scarce resource. There is lack of universal consensus towards the optimal dose of ASV in management protocol for children with severe neurotoxic snake envenomation. Objective was to compare the difference in outcome between two fixed doses of ASV, 10vials versus 20 vials, in children with severe neurotoxic snake envenomationMethods: This comparative observational study was carried out for a period of 3 years in Department of Pediatrics of SVS Medical College, Mahabubnagar, Telangana, India. Children with history of snake bite and clinical evidence of neuroparalysis were included. In addition to the mechanical ventilation and other supportive measures, every alternate patient was administered with 10vials (low dose) and 20 vials (high dose) of ASV over 1 hour. Outcome was compared between the two groups.Results: Of the 62 patients, 32 were in each group. The median time to extubation was 41 hours and 39.5 hours and mean duration of the hospital stay was 4.6 days and 4.5 days among the low dose and high dose groups, respectively. There were three deaths, one from low dose group and two from high dose group.Conclusions: There was no significant difference in outcome between the 10 vials vs 20 vials of ASV in addition to mechanical ventilation in treatment of children with severe neurotoxic snake envenomation. So, 10 vials of ASV can be utilized to reduce the cost of treatment.

show abstract

Section: Discussionsupporting

confidence: 93%

A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation

Shekar

Soren

Reddy

et al. 2020

Int J Contemp Pediatr

View full text Add to dashboard Cite

show abstract

“…The percentage decreased in prospective year to 70 % reinforcing the fact that more initiatives are needed in increasing the awareness regarding snakebite in rural population. 4,6,11,13 Snakebites in the early morning and foot being the commonest site of bite followed by legs and upper limbs was seen in both years as has been recorded in other studies. 4,11 Polyvalent ASV remained the mainstay of snakebite victims in our country knowing the fact that it is only able to neutralise the free unbound toxins.…”

Section: Discussionsupporting

confidence: 78%

“…7,14,15 One of the objectives of implementation of National and WHO STG guideline on snakebite was to practice a rational use of ASV combat it scarcity. 7,13 The practice of ASV usage in primary health centre to every patient presenting with a history of snakebite decreased in prospective year when compared with the retrospective year. The unrestrained use of ASV in retrospective year unearthed the fact mentioned in various other studies that owing to fear of death of the patients, the attending physician resolve to use ASV injudiciously.…”

Section: Discussionmentioning

confidence: 99%

“…The unrestrained use of ASV in retrospective year unearthed the fact mentioned in various other studies that owing to fear of death of the patients, the attending physician resolve to use ASV injudiciously. 13 A systemic review of randomized trials comparing high and low dose of ASV concluded that low dose have the similar efficacy and cost effective in treatment of snakebite poisoning but National STG proposes to start with 10 vials as infusion over 30 minutes for neurotoxic envenomation followed by a repeat 10 vial dose of ASV if no improvement is seen. 7,11,14 Low dose infusion therapy and high dose intermittent bolus therapy, both are followed in case of vasculotoxic snakebite.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital

Mandal

Maity

et al. 2019

Int J Basic Clin Pharmacol

View full text Add to dashboard Cite

Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases.

show abstract

“…[17] In viper bite rapid diagnosis and early administration of ASV may prevent venom induced coagulopathy and subsequent vascular complication including disseminated intravascular coagulation and renal failure. [18192021]…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of envenomation by Russell's and Echis carinatus viper: A clinical study at rural Maharashtra state of India

Bawaskar¹,

Bawaskar²

2019

J Family Med Prim Care

View full text Add to dashboard Cite

Background: Envenoming by vipers Russell’s and Echis Carinatus are common accidents faced by farmers and labors. Both viper venom toxins alter coagulation mechanism in the victim. The dose of snake antivenin to neutralize the venom is empirical and varies. Though the clinical manifestations in both vipers bite envenoming are nearly similar but dose of antivenin required is more in Russell's viper . We studied in detail about the correlation of clinical manifestations and confirmed species of snake. Methods: Cases of vipers snake bites admitted for last two successive years were studied. Analysis by local manifestations, systemic involvement, 20 minute whole blood clotting test (20WBCT), identification of snake responsible for clinical effects are confirmed by the snake species brought by victims or bystanders, in case of where victim saw the snake bur failed to kill. The victims identified from pictures of big four poisonous snakes ( Russell's viper , Echis carinatus , Cobra, and krait). Further confirmation from the species responsible is done by showing the hospital preserved specimen to identify the culprits. Findings: About 77 cases of viper bite studied of these 57 has clinical syndrome suggestive of Russell's viper (RV) bite, one has dry bite, 23 victims brought the killed specimen confirmed RV, of these 18 identified the specimen picture and 5 wrongly locate the species in pictures, 20 victims correctly identified the hospital preserved specimen while 3 failed to recognize. There were 28 patients who saw the snake while bitten but failed to kill, of these 20 patients identify correctly the species on picture while 8 failed to identify. Only 22 correctly identified the culprit by looking at the hospital preserved specimen and 6 were confused. One dry bite victim correctly identified the bitten snake species in picture and hospital preserved specimen. Interpretation: In viper bite poisoning clinical pictures and hospital specimen help to confirm the species are highly supportive for clinical diagnosis.

show abstract

Comparison of Different Dosing Protocols of Anti-Snake Venom (ASV) in Snake Bite Cases

Abstract: The modified ASV protocol used in this study is more cost effective as compared to the conventional protocol, deserves prospective evaluation and may be followed at least during prime time of scarcity of ASV.

Cited by 11 publications

References 7 publications

A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation

A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation

A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital

Diagnosis of envenomation by Russell's and Echis carinatus viper: A clinical study at rural Maharashtra state of India

Contact Info

Product

Resources

About