Management of Snakebite and Research Management of Snakebite ...

It is observed that 2-4 times amount of TRC antivenom are required to neutralize,
coagulant, defibrinogenating, necrotic and capillary permeability increasing (CPI) activities
and is equally effective in neutralizing lethal and haemorrhagic properties of the venom
where as 2-80 times of SII is required to neutralize the different biological properties of the
venom except CPI activity (128 times). It fails to neutralize the coagulant property of the
venom. Two to 40 times amount of Barat Serums are required to neutralize lethal,
haemorrhagic, necrotic, CPI and coagulant activities of the venom. Five and 64 times
amount of MPF antivenom are required to neutralize necrotic and CPI activities of the
venom.
DISCUSSION
The present study indicates that antivenom prepared with local venom achieved a better
performance in neutralizing biological activities of the venom. The differences observed in
neutralizing activities of the antivenoms could be attributed to geographical variation of
the venom (Jayanthi and Gowda, 1988) and species differences of Russell’s viper venom
used in raising the antivenoms. Geographical variation of the clinical features of Russell’s
viper bite cases from Myanmar, Thai and India (Warrell, 1986), failure of neutralization of
venom induced effects produced by Ceylonese Russell’s viper by Indian Haffkine (V.r.
puchella) antivenom (Phillips et al., 1988) and venom neutralizing efficacy of the antivenoms
(1ml reference antivenom will neutralize 2mg, MPF (1mg), SII, Barat Serums (0.6mg) and
TRC (0.4mg) of the respective venoms have been documented. Batch to batch variations
of venom used for raising MPF antivenom (Tun-Pe et al., 1996a) and variable performance
of the antivenoms (Tun-Pe et al., 1996 b) could account for variation in performance of
MPF antivenom.
Venom neutralising efficacy of SII antivenom (India) is much inferior to the Barat
Serums (India) and will require a large volume of antivenom to neutralize different biological
activities of the venom which carries risk of development of hypersensitivity reactions.
Moreover the former failed to neutralize the procoagulant activity of the venom where the
latter required 40 times amount of antivenom to achieve it. However, TRC antivenom that
required 2-4 time amount of the antivenom to neutralize the venom properties could be
an alternative choice to the MPF. But antivenom prepared with local venom is best for
treating snakebite cases from the same locality (Phillips et al., 1988) has been documented.
It is suggested that the quantity of Russell’s viper antivenom manufactured by MPF
could be made sufficient if proper clinical assessment of Russell’s viper bite cases is carried
out by the medical officers instead of giving antivenom routinely to all snakebite cases.
Continuing education of medical officers on updated management of snakebite based on
research findings is needed.
References
Neutralization of Biological Activities of Russell’s viper (Daboia russelii siamensis) Venom by Antivenoms
Hla-Myint, Hla-Mon, Maung-Maung-Khin and Thet-Win. Snakebite and envenomation (1982). In: Internal
medicine section BMA and envenomation. In: Internal medicine section BMA eds. Text book of Internal Medicine.
Burma Medical Association, 16, p10.
Jayanthi,G P and Gowda, T.V(1988). Geographical variation in India in the composition and lethality potency of
Russell’s viper (vipera russelii) venom. Toxicon,26:257-264.
75