Page 66 - JSOM Summer 2020

AFRICOM – ANTIVENOM RECOMMENDATIONS total). Administer sequentially via slow, continuous direct IV
AFRICOM – SUB-SAHARAN AFRICA/NORTH AFRICA or IO push over approximately 2 minutes each. If a reaction
FREEZE-DRIED/UNREFRIGERATED occurs stop the push, treat the reaction, reassess response to
treatment criteria. Dilute remaining dose in a 100 mL bag of
POLYSERP/Inosan, Spain: POLYSERP PAN-AFRICA Polyvalent isotonic fluids and administer via slow IV or IO infusion over
(POLYSERP-P) 30 minutes if needed.
First line (AFRICOM–SUB-SAHARAN AFRICA): Single-source a. Direct push is recommended for convenience, but POLY-
treatment option for all neurotoxic, hemotoxic, and cytotoxic SERP-P may also be administered via IV or IO infusion.
snake envenomations in sub-Saharan Africa when the causative Mix in a 50 mL or 100 mL bag of isotonic fluids and ad-
species is either unknown or among the 24 snakes for which minister the entire bag over 5–10 minutes.
this product is directly indicated. Only polyvalent to include AFRICOM – NORTH AFRICA
boomslangs and only antivenom for mole viper envenomations. FREEZE-DRIED/UNREFRIGERATED
Directly or indirectly covers all of the WHO category 1 and cat-
egory 2 snakes in this region for which an antivenom currently POLYSERP/Inosan, Spain: POLYSERP MENA Polyvalent
exists. (POLYSERP-M)
First line (AFRICOM–NORTH AFRICA): BROAD-SPECTRUM
Third line (AFRICOM–NORTH AFRICA): Indicated for all neu- treatment option for all neurotoxic, hemotoxic, and cytotoxic
rotoxic, hemotoxic, or cytotoxic envenomations in North Africa snake envenomations in North Africa (Algeria, Egypt, Libya,
with no signs of improvement after 10 vials of POLYSERP-M and/ Morocco, Tunisia, Western Sahara) when the causative species is
or NAVPC-P. Directly or indirectly covers some of the WHO cat- either unknown or among the 27 snakes for which this product
egory 1 and category 2 snakes in North Africa. is directly indicated. Directly or indirectly covers all of the WHO
Feasibility of use in austere environments: RECOMMENDED for category 1 and category 2 snakes in this region for which an an-
use in operational settings and specifically designed to fill the ca- tivenom currently exists.
pability gap for ground medics operating in these areas. Updated Feasibility of use in austere environments: RECOMMENDED for
version of Inoserp Pan-Africa made specifically for the austere use in operational settings and specifically designed to fill the ca-
and operational medicine environment. Freeze-dried, unrefriger- pability gap for ground medics operating in these areas. Updated
ated, stable at temperatures > 100° F for at least 180 days without version of Inoserp MENA made specifically for the austere and
loss of efficacy. Broad coverage and simple dosing enable admin- operational medicine environment. Freeze-dried, unrefrigerated,
istration in the field for any symptomatic snakebite by unknown stable at temperatures > 100° F for at least 180 days without loss
species in this region. Special operations and conventional units of efficacy. Broad coverage and simple dosing enable adminis-
deploying to austere operational environments and areas with tration in the field for any symptomatic snakebite by unknown
critical threat venomous species should carry 8 vials per medic. species in this region. Special operations and conventional units
It is recommended that a reserve quantity is stocked in all role 2 deploying to austere operational environments and areas with
and role 3 facilities in AFRICOM in case additional antivenom critical threat venomous species should carry 8 vials per medic.
is needed upon arrival, and also to restock field medics that have It is recommended that a reserve quantity is stocked in all role 2
used their supply. and role 3 facilities in AFRICOM in case additional antivenom
is needed upon arrival, and also to restock field medics that have
Adverse reactions: High efficacy against all major syndromes and
very low 0.2% incidence of serious adverse reactions based on used their supply.
current publications. 1,106,161–164 Adverse reactions: High efficacy against all major syndromes and
1. Indications: Broad spectrum polyvalent directly indicated for low incidence of serious adverse reactions of approximately 1%
the treatment of neurotoxic, hemotoxic, and cytotoxic enven- based on current publications. 165–172
omation syndromes caused by 24 different species of African 1. Indications: Broad spectrum polyvalent directly indicated for
snakes from the families Elapidae, Viperidae, Colubridae, and the treatment of neurotoxic, hemotoxic, and cytotoxic enven-
Atractaspididae. omation syndromes caused by 27 different species of Middle
a. NEUROTOXIC: Dendroaspis angusticeps, D. jamesoni, D. Eastern, North African, and Central Asian snakes from the
polylepis, D. viridis; Naja anchieta, N. annulifera, N. haje, families Elapidae and Viperidae. First line for snake envenom-
N. senegalensis; Naja melanoleuca ations in this region when the causative species is unknown or
b. CYTOTOXIC and/or HEMOTOXIC: Atractaspis irregu- among those for which the product is directly indicated.
laris; Bitis arietans, B. gabonica, B. nasicornis, B. rhino ceros; a. NEUROTOXIC: Naja haje, N. oxiana; Walterinnesia
Cerastes cerastes; Dispholidus typus; Echis leucogaster, E. aegyptia
ocellatus, E. pyramidum; Naja katiensis, N. mossambica, b. CYTOTOXIC and/or HEMOTOXIC: Bitis arietans; Cer-
N. nigricollis, N. nubiae, N. pallida astes cerastes, C. vipera, C. gasperettii; Daboia palestinae,
2. Pretreatment: NOT ROUTINELY INDICATED unless patient D. mauritanica, D. deserti; Echis. carinatus sochureki, E.
is unstable, asthmatic/atopic, known hypersensitivity or other coloratus, E. khosatskii, E. leucogaster, E. megalocephalus,
pretreatment criteria met. Low risk of severe allergic reactions E. omanensis, E. pyramidum; Macrovipera lebetina obtusa,
and other EARs. M. l. transmediterranea, M. l. turanica; Montivipera born-
3. Initial dosing by syndrome: muelleri, M. raddei kurdistanica; Naja nubiae, N. pallida;
a. NEUROTOXIC initial dose = 6 vials Pseudocerastes persicus persicus, P. fieldi; Vipera latastei
b. HEMOTOXIC initial dose = 6 vials 2. Pretreatment: NOT ROUTINELY INDICATED unless patient
c. CYTOTOXIC initial dose = 6 vials is unstable, asthmatic/atopic, known hypersensitivity or other
4. Additional dosing: Additional doses of 2 vials POLYSERP-P pretreatment criteria met. Low risk of severe allergic reactions
may be given at hours 2, 4, 6, 12, and 24 if needed. and other EARs.
5. Preparation and administration: Reconstitute every 2 vials of 3. Initial dosing by syndrome:
POLYSERP-P in the same 10 mL syringe by mixing the first a. NEUROTOXIC initial dose = 6 vials
vial, drawing it back up into syringe, and injecting it into the b. HEMOTOXIC initial dose = 6 vials
second vial to yield 2 vials/1 syringe (6 vial dose = 3 syringes c. CYTOTOXIC initial dose = 6 vials

64 | JSOM Volume 20, Edition 2 / Summer 2020