Safe snake antivenom

Abstract

Snakebite is a WHO-listed neglected tropical disease. Bites result in an estimated 421 000 envenomings and 20 000 deaths globally each year, although the incidence may be as high as 1 800 000 envenomings and 94 000 deaths. Antivenom is the mainstay of treatment of snakebite envenoming. However, adverse reactions to poor quality snake antivenom that is available are common in many parts of the world, particularly South Asia, where snakebite is prevalent is a major problem. Both acute (anaphylactic or pyrogenic) and delayed (serum sickness type) reactions occur. Acute reactions are usually mild but severe systemic anaphylaxis may develop, often within an hour or so of exposure to antivenom. Serum sickness after antivenom has a delayed onset between 5 and 14 days after its administration. Ultimately, the prevention of reactions will depend mainly on improving the quality of antivenom. Until these overdue improvements take place, doctors will have to depend on pharmacological prophylaxis, where the search for the best prophylactic agent is still on-going, as well as careful observation of patients receiving antivenom in preparation for prompt management of acute as well as delayed reactions when they occur.