Affinity purified European viper antivenom 100mg/4ml solution for infusion vials

IntroductionSnakebite is a neglected tropical disease that leads to more than 120,000 deaths every year. In 2019, World Health Organization (WHO) launched a strategy to decrease its global burden by 2030. There is a range of issues around different interventions for the management of snakebite. Decisions around these interventions should be informed by evidence from systematic reviews (SR).MethodsAn overview of SRs was conducted by searching 12 electronic databases, PROSPERO, contacting experts and screening the bibliography of included reviews. Screening, data extraction, and quality assessment (through AMSTAR-2) was done by at least two overview authors independently with discrepancies sorted by consensus. A narrative synthesis was conducted.Principle findingsThe overview found 13 completed SRs that has looked at various aspects of management of snakebite envenomation. There was one SR on first aid, nine on effectiveness and safety of snake anti-venom (SAV), two on drugs to prevent adverse reactions due to SAV therapy, and one on surgical interventions for management of snakebite envenomation. All, except one, SR was appraised to have critically low confidence as per AMSTAR-2 Criteria. Evidence base was restricted to few studies for most interventions.DiscussionHigh quality evidence from SRs is required to inform guidelines and health system decisions which can bring down the burden of snakebite. The review indicates the need to fund high-quality SRs, evidence gaps and core outcome sets which can inform guideline recommendations, funding priorities for conduct of future trials. Variation in species distribution as well as intra-species variation in venom composition implies the need for conduct of region or, nation or state (sub-national) specific randomised controlled trials and SRs on different SAVs and their dosing regimens.

Abstract licence: CC BY

Although there are over 5 million cases of snakebites each year, up-to-date data on epidemiology and management in European children are lacking in literature. Snakebite envenoming is a rare but potentially life-threatening event, and children are more susceptible due to their lower weight-to-venom ratio. Symptoms of viper envenomation in children are mainly local, but the lymphatic and blood diffusion of the venom may cause systemic symptoms, mainly hemotoxic and cytotoxic symptoms. Immunotherapy with anti-viper serums is the cornerstone of treatment for viper bites, while the use of antibiotics, steroids and analgesics is still unclear and unstandardized. Recently, efforts have been made to improve the pediatric approach to viper envenomation in European children. Several pediatric case reports in children were reported in literature, and a pediatric grading severity score and electronic clinical tool (VipGrade®) were created to better manage this issue. However, larger studies are needed to validate these pediatric tools. This narrative review focuses on the clinical characteristics and management of European snake envenomation in children.

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BackgroundSnakebites caused by Bitis nasicornis and Bitis gabonica are rare but can lead to severe systemic and local complications, including acute compartment syndrome (ACS). The role of surgical intervention in snakebite management remains controversial, with limited data available for snakebite envenomation.Case presentationTwo cases of upper limb envenomation by Bitis nasicornis and Bitis gabonica were managed at the General University Hospital in Prague in year 2024. Both developed acute compartment syndrome requiring prompt antivenom therapy, fasciotomy, and intensive care. In the first case, antivenom (EchiTab-Plus-ICP) was given within 1 h, 10 vials in total, and fasciotomy at 10 h; the patient was discharged on day 16 with preserved limb function. In the second, antivenom (SAIMR) was administered within 3 h, 4 vials in total (the maximum available in Europe at that time), and fasciotomy at 8 h; recovery was complete by day 7. Diagnosis of ACS was based on clinical signs without intracompartmental pressure measurement.ConclusionThese cases highlight that timely surgical intervention, combined with intensive care and antivenin may play a critical role in preventing irreversible tissue damage following viperid envenomation. However, universal guidelines are lacking. Incorporating intracompartmental pressure monitoring into treatment protocols may further improve diagnostic accuracy and patient outcomes.

Abstract licence: CC BY