Risks and realities of single vial antivenom recommendations for envenoming by Australian elapid snakes

Scott A Weinstein, Peter J Mirtschin and Julian White
Med J Aust 2019; 211 (11): . || doi: 10.5694/mja2.50314
Published online: 23 September 2019

Antivenom dosage for Australian elapid envenoming should be decided by clinical evaluation of individual patients

Snakebite is arguably the most important type of envenoming, both worldwide and in Australia, but evidence‐based management remains unclear and controversial. This is particularly evident in Australia, where it has been advocated that antivenom dosing should be limited to a single vial,1 an opinion that is commonly questioned among physicians treating snakebites. Conducting standardised clinical research on envenoming is challenging, particularly in countries like Australia, where numbers of envenomed people are relatively low and scattered geographically. Globally, snakebite particularly affects the rural poor in developing nations, where surveillance, let alone model clinical research, is problematical. Antivenom remains the cornerstone of management for snakebite, supplemented by other tools such as intensive care medicine, mechanical ventilation and haemodialysis. Antivenom use worldwide is complicated by variability in quality, availability and dosing.

  • Scott A Weinstein1
  • Peter J Mirtschin2
  • Julian White1

  • 1 Women's and Children's Hospital, Adelaide, SA
  • 2 Venom Science, Adelaide, SA


Competing interests:

Julian White provides advice to Seqirus, manufacturer of antivenoms used in Australia, as part of a contract between his employing hospital and Seqirus. He occasionally receives travel support to attend toxinology meetings from Seqirus. However, he does not receive any financial remuneration or other compensation from Seqirus, and Seqirus has no role, input or influence on any of his reports, clinical practice or comments. He also provided an invited opinion in the referenced coronial cases. Peter Mirtschin provided independent commentary included in the coronial reports and is owner of Venom Supplies in the Barossa Valley, SA, a business that is leased to others; this business occasionally conducts business with Seqirus, but he has no input into, and does not receive any financial remuneration or other compensation from, Seqirus.


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