Saving lives and resources: antivenom dose drop in Australia

Jul 31 2017

Professor Geoff Isbister Antivenom dose drop in Australia

Revised clinical practice recommending a reduced antivenom dose for snakebite victims has been shown to be successful, signifying huge financial and waste savings for Australian hospitals.

Costing between $347 and $2320 per vial, and with a shelf life of only one to three years, all hospitals are required to have antivenom on site. Due to the rarity of cases, the expensive treatment may go to waste.

A new report, published in the Medical Journal of Australia on the Australian Snakebite Project, outlines 10 years of snakebite treatment nationally and found no negative implications of administering a reduced dose of antivenom to affected patients. The report also highlighted the importance of some first aid practices for those presenting with a snakebite.

Professor Geoff Isbister, University of Newcastle (UON) clinical toxicologist and member of HMRI’s Cardiovascular program, said the results were significant in backing the change to clinical practice.

“The success of a steady decline in antivenom dose, although seemingly small, has huge implications for hospitals, including the potential to save millions of dollars from not having to stock as much,” he said.

The study reviewed 1548 patients who presented with a snakebite, which included 835 patients who presented with envenomation and 23 deaths over the 10 year period.

The results brought to light the importance of certain first aid practices, such as basic life support (cardiopulmonary resuscitation) in patients who collapse after a snakebite, as well as recommended changes to testing.

“Our study found that snake venom detection kits, which are used after patients present with a suspected bite, were used inappropriately in non-envenomed patients, leading to a 36 per cent false positive rate. Their results were also incorrect in 17 per cent of envenomed patients.

“Due to these inaccuracies, the kits are no longer an essential component of snakebite treatment.”

Moving forward, Professor Isbister stressed that improving diagnosis and reducing the time between snakebite and treatment should still be of paramount priority.

“Reducing that interval is an important and achievable goal for improving treatment.

“As there is a risk of anaphylaxis in patients who receive antivenom but haven’t been poisoned, there is a need for focus on improving the early diagnosis, which is often undertaken in small or remote health care facilities with minimal specialist support,” he said.

*HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.

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