Letters
Emergency medicine
Volume 198 - Issue 4

Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13)

Authors:  Geoffrey K Isbister, Nicholas A Buckley and Simon GA Brown

Med J Aust 2013; 198 (4): 194-195. || doi: 10.5694/mja12.11690
Published online: 4 March 2013
In reply: A low-volume, polyvalent antivenom for brown and tiger snake envenoming would make treatment simpler and safer. Since 2001, when information cited by Paul was published, there have been over 15 peer-reviewed research publications addressing the issue of antivenom dosing.1-3 There is now consistent evidence that one vial is equivalent to larger doses, and there have been no cases of active venom being present after one ...
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In reply: A low-volume, polyvalent antivenom for brown and tiger snake envenoming would make treatment simpler and safer.

Since 2001, when information cited by Paul was published, there have been over 15 peer-reviewed research publications addressing the issue of antivenom dosing.1-3 There is now consistent evidence that one vial is equivalent to larger doses, and there have been no cases of active venom being present after one vial of antivenom.1-3 This research has led to updated Australian guidelines for antivenom dosing.4,5

We reported the results of the snake venom detection kit (sVDK) by the treating hospital and proved that many incorrect diagnoses were made in real-life conditions.3 Most operators would not have received training and in rural and remote hospitals, clinicians need to cover the most likely snakes consistent with the clinical picture. We recommend using the correct antivenom for all snakes but antivenom cross-reactivity means that patients inaccurately classified by the sVDK and given the wrong antivenom may still be covered.

Australian doctors need access to an approved, low-volume, polyvalent antivenom covering brown and tiger snake venom, similar to the veterinary product already available. This would cover most patients presenting with snake envenoming and coagulopathy in Australia. It would avoid the need for the sVDK in most cases, making antivenom administration simpler and safer.

We encourage CSL to update its product information to reflect the latest evidence and to develop a suitable polyvalent antivenom, and we encourage clinicians to follow independent expert guidelines such as the Therapeutic guidelines.5 These recommend one vial of appropriate antivenom for all snake envenoming. Expert advice is available from the national poisons centre network (phone 131 126).

Authors

  • Geoffrey K Isbister1,2
  • Nicholas A Buckley3,4
  • Simon GA Brown5
  • 1. Discipline of Clinical Pharmacology, University of Newcastle, Newcastle, NSW.
  • 2. Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, NSW.
  • 3. NSW Poisons Information Centre, Sydney Children’s Hospital Network, Sydney, NSW.
  • 4. Medical School, University of New South Wales, Sydney, NSW.
  • 5. Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, WA.

Correspondence: geoff.isbister@gmail.com

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library