Judicious use of antisnake venom in the present period of scarcity

CONTEXT Although antisnake venom (ASV) has been used for many years, selection of an optimal dose is a debated issue due to acute shortage of ASV in India. Despite evidence for smaller doses, most centers still use conventional doses. AIMS This study aimed to evaluate the effects of two different dosage regimens on the outcome of patients with snake envenomation, using a retrospective descriptive analysis of patient records admitted in our hospital. SETTINGS AND DESIGN A retrospective descriptive case series study was conducted from hospital records consisting 155 snakebite patients from June 2013 to January 2014. MATERIALS AND METHODS PATIENTS WERE DIVIDED INTO TWO GROUPS: Low dose ASV group (received <10 vials) and high dose ASV group (received ≥10 vials). Various complications were compared among these two groups. RESULTS The mean dose of ASV used in high dose, and low-dose group was 14.7 ± 5.3 and 4.2 ± 2.3, respectively. In low dose group, 20.5% of patients had acute kidney injury, whereas it was 10.9% in high dose group. In low dose group, 12.3% patients had neuroparalysis severe enough to require ventilator support and mortality rate was 5.5% which was comparable to the high-dose group (15.8% had neuroparalysis requiring ventilator support and a mortality rate of 8.5%). CONCLUSION This study demonstrated that the low dose ASV regimen in poisonous snake bites along with supportive treatment as necessary is as efficacious as high dose regimen and has comparable complications.