Delayed antivenom for life-threatening tiger snake bite: Lessons learnt

Snake Antivenoms-Toward Better Understanding of the Administration Route

Envenomations induced by animal bites and stings constitute a significant public health burden. Even though a standardized protocol does not exist, parenterally administered polyclonal antivenoms remain the mainstay in snakebite therapy. There is a prevailing opinion that their application by the i.m. route has poor efficacy and that i.v. administration should preferentially be chosen in order to achieve better accomplishment of the antivenom therapeutic activity. Recently, it has been demonstrated that neutralization not only in the systemic circulation but also in the lymphatic system might be of great importance for the clinical outcome since it represents another relevant body compartment through which the absorption of the venom components occurs. In this review, the present-day and summarized knowledge of the laboratory and clinical findings on the i.v. and i.m. routes of antivenom administration is provided, with a special emphasis on the contribution of the lymphatic system to the process of venom elimination. Until now, antivenom-mediated neutralization has not yet been discussed in the context of the synergistic action of both blood and lymph. A current viewpoint might help to improve the comprehension of the venom/antivenom pharmacokinetics and the optimal approach for drug application. There is a great need for additional dependable, practical, well-designed studies, as well as more practice-related experience reports. As a result, opportunities for resolving long-standing disputes over choosing one therapeutic principle over another might be created, improving the safety and effectiveness of snakebite management.

The clinical efficacy of Zuqing Xu "Wuduling" powder for snake injury on the swelling of the affected limb bitten by Agkistrodon halys

To determine the clinical efficacy of Zuqing Xu 'Wuduling' powder for snake injury on the swelling of the affected limb bitten by Agkistrodon halys. Sixty-five patients with Agkistrodon halys bite were assigned to a treatment group (n = 35) or control group (n = 30). The treatment group was additionally given 'Wuduling' powder dressing locally based on the therapy to the control group with conventional Western medicine. Clinical efficacy and improvement of traditional Chinese medicine symptoms and signs in the two groups were evaluated. The treatment group showed a notably higher cure rate than the control group. After 3 days of therapy, the swelling and pain of the affected limb in the treatment group were greatly alleviated. Additionally, after 7 days of therapy, the swelling and pain of the affected limb in the treatment group were more greatly alleviated, and those in the control group were also alleviated. The comparison of the two groups during the same period showed more obvious alleviation of swelling and pain in the treatment group than that in the other. Moreover, the treatment group experienced notably shorter disappearing time of swelling and pain than the control group. After treatment, the levels of CRP, TBIL, Cr, ALT, AST, BUN, CK, LDH and CK-MB in both groups declined notably, with notably lower levels of them in the treatment group than those in the other. Zuqing Xu 'Wuduling' powder for snake injury can substantially alleviate the swelling and local pain of affected limbs bitten by Agkistrodon halys.