Page 67 - JSOM Summer 2020

4. Additional dosing: Additional doses of 2 vials POLYSERP-M b. If a severe reaction such as anaphylaxis occurs, stop the
may be given at hours 2, 4, 6, 12, and 24 if needed. infusion and treat according to the anaphylaxis protocol
5. Preparation and administration: Reconstitute every 2 vials listed elsewhere in the CPG. Reassess the patient once the
of POLYSERP-M in the same 10 mL syringe by mixing the reaction has been controlled and resume the infusion at
first vial, drawing it back up into syringe, and injecting it a slower rate if any of the specific criteria for antivenom
into the second vial to yield 2 vials/1 syringe (6 vial dose = treatment listed elsewhere in the CPG have not completely
3 syringes total). Administer sequentially via slow, contin- resolved.
uous direct IV or IO push over approximately 2 minutes
each. If a reaction occurs stop the push, treat the reaction, AFRICOM – SUB-SAHARAN AFRICA
reassess response to treatment criteria. Dilute remaining LIQUID/REFRIGERATED
dose in a 100 mL bag of isotonic fluids and administer via South African Vaccine Producers, South Africa: SAVP SAIMR
slow IV or IO infusion over 30 minutes if needed. Polyvalent Snake Antivenom (SAIMR-P)
a. Direct push is recommended for convenience, but POLY- Second line (AFRICOM–SUB-SAHARAN AFRICA): Unknown
neurotoxic and/or cytotoxic envenomation in sub-Saharan Africa
SERP-M may also be administered via IV or IO infusion.
Mix in a 50 mL or 100 mL bag of isotonic fluids and ad- or with no indications of improvement after 10 vials of POLY-
SERP-P. Will not treat hemotoxic envenomations. SOUTHERN
minister the entire bag over 5–10 minutes.
AFRICA: Directly or indirectly covers all WHO category 1 and
AFRICOM – SUB-SAHARAN AFRICA category 2 species for which an antivenom currently exists. EAST/
LIQUID/REFRIGERATED CENTRAL/WEST AFRICA: Covers many cytotoxic and neu-
South African Vaccine Producers, South Africa: SAVP SAIMR rotoxic snakes in West, Central, and East Africa but has major
Boomslang Monovalent (SAIMR-B) coverage gaps with no efficacy against all WHO category 1 or
Second line, boomslang only (AFRICOM–SUB-SAHARAN AF- category 2 hemotoxic snake species.
RICA): Confirmed or suspected boomslang bite with no indica- Feasibility of use in austere environments: NOT RECOM-
tions of improvement after 10 vials of POLYSERP-P. Monovalent MENDED for operational settings. Requires cold chain refrigera-
that can only be used to treat the WHO category 2 boomslang. tion. Recommend storing small quantities at strategically located
Does not provide coverage against any other WHO category 1 or Role 2 & 3 facilities in AFRICOM AOR.
category 2 species.
Adverse reactions: High efficacy but very high rates of anaphy-
Feasibility of use in austere environments: NOT RECOMMENDED laxis ranging from 25%–75% have been documented in multiple
for operational settings. Requires cold chain refrigeration. Recom- publications. 50,174–180
mend storing several vials at a small number of strategically located 1. Indications: This polyvalent can be used to treat neurotoxic
Role 2 & 3 facilities in sub-Saharan Africa. and cytotoxic envenomations by 10 different species of Afri-
can snakes. The product has been used successfully to treat
Adverse reactions: No clinical trials but effective anecdotally and additional species of African snakes through paraspecific neu-
in case reports. Moderate to high rates of anaphylaxis are antic-
173
ipated based data from related SAIMR-P polyvalent. 174–180 tralization, but research in this area is limited and most experi-
ences are anecdotal. The 10 species listed below are the official
1. Indications: This monovalent is only effective for the boomslang.
a. HEMOTOXIC: Dispholidus typus treatment indications recommended by the manufacturer:
2. Initial dosing by syndrome: a. NEUROTOXIC SNAKES: Dendroaspis polylepis, D. an-
a. NOT INDICATED FOR NEUROTOXIC gusticeps, D. jamesoni, Naja melanoleuca, N. nivea, N.
annulifera
b. HEMOTOXIC with CONFIRMED OR SUSPECTED
BOOMSLANG BITE (typical onset coagulopathy and b. CYTOTOXIC SNAKES: Bitis arietans, B. gabonica, Naja
mossambica, Hemachatus haemachatus
bleeding 1–3 days after the bite; no significant pain, swell- 2. Initial dosing by syndrome:
ing, or tissue destruction) NEUROTOXIC initial dose = 10 vials
i. Initial dose = 2 vials SAIMR-B
1. POLYSERP-P should be the first line treatment for a. NOT INDICATED FOR HEMOTOXIC
b. CYTOTOXIC initial dose = 10 vials
this species if available due to lower risk of allergic
reactions. 3. Additional dosing: Additional doses of 5 vials SAIMR-P may
c. NOT INDICATED FOR HEMOTOXIC envenomation by be given at hours 2, 4, 6, 12, and 24 if needed.
snakes other than the boomslang 4. Pretreatment: RECOMMENDED for this antivenom. Ad-
d. NOT INDICATED FOR CYTOTOXIC minister 0.25 mg epinephrine injected SQ prior to beginning
3. Additional dosing: Additional doses of 1 vial SAIMR-B may antivenom infusion to reduce the risk of a serious reaction.
Pediatric epinephrine dose is weight based (0.01 mg/kg).
be repeated, if needed, at hours 2, 4, 6, 12, and 24 until cessa-
tion of all active bleeding or at 6, 12, and 24 for coagulopathy 5. Preparation and administration: Dilute the entire dose of an-
tivenom in a single 250–500 mL bag of isotonic solution and
without bleeding.
4. Pretreatment: RECOMMENDED for this antivenom. Ad- administer by intravenous infusion over 10–30 minutes.
a. If a mild or moderate reaction occurs, slow the infusion and
minister 0.25 mg epinephrine injected SQ prior to beginning
antivenom infusion to reduce the risk of a serious reaction. Pe- treat symptomatically with antihistamines, steroids, and/or
antiemetics as needed.
diatric doses should be weight based at a dose of 0.01 mg/kg,
up to 0.25 mg. b. If a severe reaction such as anaphylaxis occurs, stop the in-
5. Preparation and administration: Dilute the entire dose of an- fusion and treat according to the anaphylaxis protocol listed
tivenom in a single 100 mL bag of isotonic solution and ad- elsewhere in the CPG. Reassess the patient once the reaction
has been controlled and resume the infusion at a slower rate
minister by intravenous infusion over 10 minutes.
a. If a mild or moderate reaction occurs, slow the infusion and if any of the specific criteria for antivenom treatment listed
elsewhere in the CPG have not completely resolved.
treat symptomatically with antihistamines, steroids, and/or
antiemetics as needed.

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